I did it. I finally switched from TRICARE Prime to TRICARE Standard. I’ve been a military spouse for ten years, and I never really considered Standard to be an option for my family . . . until now.
Don’t get me wrong, I LOVE TRICARE Prime. I loved knowing that when I take my children to the doctor, I wouldn’t get a bill. If I had to call an ambulance and bring them to the hospital, there wouldn’t be a bill. If someone needed a surgery, or was diagnosed with some scary medical problem, there wouldn’t be a bill.
I thought I couldn’t afford a bill.
Today, I’ve realized that it’s not the bill I should be worried about. I can no longer afford the care we’ve received at our Military Treatment Facility (MTF). As a working mom, I can’t afford to wait three hours at the pharmacy for prescriptions. As a mother of four, I can’t afford not being able to get my child into the doctor when they have an ear infection, or heaven forbid, pink eye, which left untreated will spread to ALL of my children.
I can’t afford to ignore my own health issues any longer, either. I can’t afford the time it takes to fight for referrals, or wait the three months until there is an opening at the specialist, or wait the six months the MTF told me it would take to get my child a referral for a mental health evaluation.
My family is in crisis; I can’t afford to ignore red flags any longer.
What I CAN afford is the co-pay for TRICARE Standard.
We switched to Standard two weeks ago, and let me tell you what happened:
I got online, and found doctors within the network. I found and called the specialists we needed and made an appointment, no referrals needed. In a half hour, I was able to schedule four appointments with a pediatrician, one appointment with a family practice doctor, a neuropsych evaluation, and an appointment with a specialist I have been asking to see for the last year. All of the appointments were scheduled for the next two weeks.
When I walked into my appointment at the specialist, I met a physician who listened to my symptoms, and immediately scheduled further testing…for the next day. During that test, he discovered a problem that will need surgery very quickly. This diagnosis explains all the symptoms I had been complaining about to the doctors at the MTF and military emergency rooms for the past year. I believe I could have (and should have) had this surgery a year ago, if one of the Primary Care Manager (PCM) I saw at the MTF (because I never did see the same PCM twice) had given me the referral I had asked for, by name, again and again.
Two weeks is all it took for me to get every last person in my family the medical care they need and deserve.
So what will it cost me? Every last penny I will spend on our healthcare this year is worth it. For my family of six, I will pay a $300 deductible before the coverage kicks in. We have already paid this within the first two weeks–we needed a lot of testing, procedures, appointments, and prescriptions! After I pay that deductible, we will continue to pay co-pays up until we hit a $1000 dollar catastrophic cap. My family will likely hit that cap, due to the special needs and health issues we are dealing with. Once we hit that amount, I will pay nothing else, until the following year.
There were times my family could not have afforded to pay a thousand dollars a year for health insurance, and during those times, and I am grateful my husbands service earned us TRICARE Prime healthcare coverage.
I know I’m not alone with the decision to switch to TRICARE Standard because my family couldn’t get the care they needed, when they needed it. Remember Sequestration? Remember when MTF’s were closed for a number of days each week and no one could get care? My problems, and others’, isn’t the fault of the doctors and PCM’s, in most cases, it’s the policymakers who can fix this for military families. My family deserves the best care, no matter which plan we’re on. So does yours.
The National Military Family Association continues to fight for military families like yours and mine by asking Congress to end Sequestration and the unfair burden it puts on military families. And this year, NMFA is putting a heavy focus on TRICARE reform and the health proposals in the Fiscal Year 2017 budget.
Right now, I can’t afford to NOT to pay the thousand dollars for my family’s healthcare. I am kicking myself for not transitioning to Standard sooner. I could have gotten my son the evaluations, help, and services he needed sooner. I could have received the preventative care I needed sooner. I could have saved myself so much stress and time spent waiting on referrals and prescriptions, and time spent sitting in the waiting room at the ER when appointments were unavailable at the MTF.
I could have saved so much, had I switched sooner.
Did your family switch from TRICARE Prime to TRICARE Standard? What would you tell Congress about your experience?
Posted by Heather Aliano, Social Media Manager