Sick and Tired: Military Kids Need Better Access to Same-Day Care at MTF


Child-at-MTFRecently, when a military spouse at our Association told me she had to take her baby to the emergency room when there were no appointments at their Military Treatment Facility (MTF), I thought my head was going to explode.

I flashed back to one of many similar situations I faced when we were on TRICARE Prime, and my daughter, Kate, was in her ‘ear infection phase.’ On one memorable occasion, Kate started a fever on a Friday night (of course, after the MTF was closed for the weekend). By Saturday, the telltale ear tugging and crankiness were in full swing. I kept my fingers crossed that we could keep things under control with Motrin and Tylenol until the clinic reopened on Monday. Unfortunately, by Sunday she had a 104 degree fever, obvious signs of a ruptured ear drum (I’ll spare you the details), and was crying inconsolably.

I knew we couldn’t wait until Monday for an MTF appointment, so with a newborn crying to be fed and a 20 month old wailing in pain, I braced myself for an uphill battle to find medical care that TRICARE would cover.

I consulted the TRICARE website where it seemed like our only option was the emergency room. This concerned me; did a ruptured ear drum constitute a threat to life, limb, or eyesight? I was terrified of having to foot the bill for an ER visit.

Not willing to risk it, I called TRICARE. They told me to take Kate to a network urgent care and call our primary care manager (PCM) on Monday to request a referral.

I think you know where this story is going…

On Monday, I called our PCM, who refused to give me a referral because the appointment had already taken place. When I called TRICARE back, their hands were tied. Without a referral, they could not pay the urgent care provider. We were at an impasse, and eventually paid out of pocket for that visit.

The reason this particular incident is burned into my memory is because it occurred while I was recovering from a c-section, and we were about a week away from PCSing. My husband’s new unit had orders to Iraq, but the departure date kept moving, causing second and third order effects… most notably on our temporary housing plans. Oh, and we had just learned (from CNN – surprise!) that Army deployments were being extended to 15 months.

Military families lead complicated lives full of uncertainty. Getting a sick child appropriate medical attention should NOT be complicated.

The National Military Family Association has advocated for years to fix this problem.

And, in fairness, things have improved.

Sometimes.

At certain locations.

For instance, our old MTF in Virginia, the Woodbridge Clinic, is gone now. It’s replaced with the Dumfries Clinic, which has improved appointment access by adding Saturday hours.

Yet, we still hear of too many instances where families can’t get same-day appointments at the MTF, are refused referrals to urgent care, and are left with no option but the emergency room for their sick kids.

This is just wrong.

As the health care subject matter expert for our Association, this issue is not only my job, it’s personal. Now is the time to fix this problem once and for all. Military families deserve access to the best care, including same-day appointments for urgent issues.

Please help us by signing our petition and sharing your experience with access to same day appointments in the comments below.

karen-rPosted by Karen Ruedisueli, Government Relations Deputy Director

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  1. 1
    Carmen

    What exactly is this petition going to do? You can’t just sign a petition and hope that will change things.

    All I see is complaining that things need to be fixed, but I don’t see any solutions either. You want same day appointments for urgent issues? Please point me in the direction of someone who has a feasible plan to fix this issue? Do you plan on changing the amount of people that can be stationed at a base? Do you want to change deployment schedules so that more doctors are available at MTF’s? Would you like to create doctors and health care providers out of thin air? Would you like to force healthcare providers to move to remote locations? You want civilian urgent care facilities & doctors who don’t take Tricare to decide to take Tricare? If the answers SO simple, and so clear, please enlighten us on YOUR proposal.

    FYI, you have some big proposals to make. Not every area has these problems. Some of these issues are specific to certain locations. When you make blanket statements, you confuse people. Now there are people up in arms about urgent car and ER’s when getting referrals to urgent care isn’t a problem in their area! All I see is confusion over what? Nothing! Nothing is changing! Your Tricare handbook is still a wealth of factual information!

    There are dependents who don’t even know the difference between Prime & Standard, MTF or civilian doctors. You’d be well served to educate people on how Tricare works before confusing people who have no idea how the system works. Believe me, from reading Facebook posts on this issue and Tricare overhaul (tabled in the House) many people have absolutely no idea how Tricare works.

    • 2
      Branching Out: A blog by the National Military Family Association

      Carmen – thanks for your comment. You’re right, we can’t just sign a petition and hope things will change. But it does military families no good to sit and do/ask for nothing, either. The system is broken, and we are hoping our efforts can change this. Our Association had a big hand in Congress’ repeal of COLA cuts, and that would never have happened if military families (and the organizations and people who support them) didn’t speak up. Do you have any affiliation with the military?

      We understand that some complaints may not be followed with solutions or proposals, but we believe this is the job of our Nation’s leaders to decide. Our Association is a trusted resource and advocate that these leaders turn to for a boots-on-the-ground perspective, and we most certainly offer proposals and recommendations as appropriate.

      What proposals would you make to help military families get better access to same-day care, rather than going to the ER and be charged a fee because they have no other option for care?

      • 3
        Dan N

        I think it’s obvious that Carmen works for Tricare and/or the medical community, and she sees this post as an attack on her and the job she’s doing. I’m military but not in the medical community, and I think it’s important to note that for the most part our medical providers try and do the very best they can with the constraints they have. I’ve had Tricare and medical providers bend over backwards to help us when we had special circumstances, but shared the same frustration as the author when the system didn’t allow for something that would seem the best course of action. I also have no answers as I don’t know Tricare or medical well enough to provide answers, but I do know that it will be an uphill battle with the budgetary and personnel cuts that are directed towards the military. I applaud your efforts. Keep up the good work spreading the knowledge.

      • 4
        Carmen

        Yes I am a part of the military community. I was born into it and married into it. I’ve been a dependent continuously for 35 years.

        I don’t have any proposals or solutions because there are no actual details behind the proposal of charging a fee. You (and I) have absolutely no idea where these fees would be charged and under what circumstances. You have absolutely no idea if somebody would be charged a missuse fee because their primary doctor is full. As it stands now, if you go to civilian doctor for a nonemergency the penalty is that Tricare won’t pay the bill. It’s always been in the handbook. I don’t see you lobbying against that. Why? Maybe it’s because the Tricare generally pays these ER bills anyway. It’s in the rules. We break the rules (for good reason). But we don’t get penalized for it. There are many things in life that seem unfair and we break the rules and we get the penalized for breaking the rules. As much is you want to believe that people go to the ER for non- ER purposes when there’s no room at the doctor, I’m sure there are a lot of beneficiaries that truly abuse the ER as well. Did it ever cross your mind that the proposed ER fee would be put in place to try to curb true misuse of the ER? How do you save money in a healthcare system that is bleeding profusely?

        When you look at the actual 2016 budget proposal that has all of the costs shares and amount amounts there’s a box there for urgent care. If you can make a statement that the 2016 budget proposal allows for a ER misuse fee, it also stands to reason that you can say that urgent care will now be covered (for anyone who has access) as well. It’s right there on the budget report! We speculate so much about what looks bad on the budget proposal but we don’t say anything about what looks good.

        Furthermore after this was tabled in the House, you really think that the Senate is going to push it through? Although there might be a very, very slight chance that this budget might actually be approved this year, our government really has no interest in dealing with Tricare and commissaries right now. Well, at least half of it doesn’t. You do know that there is a proposal that was written in 2014 with proposed changes all the way up into the next decade, right? there’s plenty in that report to be upset about too.

        Why do we want to believe that everything the government proposes will be pushed through when it seems like they’re against us. But when we come to find out that they’re actually not against us and they have no plans to change anything, we shove that tidbit under the carpet.

        Do I care that on the other side of the country people are having problems with getting in to see their primary care doctor in a timely fashion? Sure. Been there. But there are other things that I care about more that affect me. For instance, there are certain drugs that my civilian doctors have prescribed that Tricare does not cover or wants me to waste money on trying other drugs before they will approve the one that my doctors knows is the best choice for me. There are also prescription savings cards (issued by the manufacturer) that I could use to help pay for these drugs. But these prescription savings card’s specifically say (because of a federal agreement) that since I have a federally backed insurance plan I cannot use these prescription savings cards. It doesn’t matter if I won’t even be using Tricare and will pay 100% out of pocket. The fact that I am under a federally insured insurance policy prohibits me from receiving any savings from the manufacturer. This is a problem that matters to me.

        I’m sure that there are lots of fantastic things that your organization does for military families, but have you been on social media and seen what a total cluster this issue has been? Confusion galore! There are people who actually believe that this is a done deal just by your organization stating that you object to an ER misuse fee with no clear information to how the fee would actually be used. I can’t get behind saying “no” to something when I have absolutely zero details. I like to make informed decisions and there is just no public information about the subject of ER misuse fees. I do know what the Tricare handbook says about ER misuse. That exists. It’s real. How about changing that?

  2. 6
    Eric Duckworth

    Tricare Standard is a good route to go and it eliminates your problem. The co pays are extremely reasonable. If you go Prime, you kinda get what you pay for. good, Cheap, Fast…you can have two, but never three.

  3. 7
    Vet/Spouse

    Thank you for bringing this issue the attention it deserves.

    As a former Soldier and now wife of an Active Duty Soldier and parent of 4 kids, it is insanity that our families are being disparaged as abusers and takers.

    Military pay and benefits are offered in a compensation package. Right now, healthcare for Active Duty is free.

    Pay should be increased to meet the increasing fees, if and when that occurs.

    If there are no appointments, if the MTF is closed for a 4 day, weekend, if there are no urgent care clinics in the area, how are we expected to obtain care?

    Urgent care referral process is not uniform. Some areas have many urgent care centers, some have none.

    Some areas allow retro referrals. You can get treated at an urgent care center, then call and get a referral later.

    We have not had that experience. Our PCM has a 24-72 hour phone call return time.

    The last time I called our PCM, he did not return my call for 4 days. He was apologetic and said he was swamped…that’s understandable, but patients need a system to access care, not play guessing games as to what has to occur to get care.

    Patients should not be blamed for trying to access care for themselves and their families.

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