TOPICS
TOPICS
Panel investigates military family TRICARE complaints
The House Armed Services Committee is investigating complaints from military families who claim the Pentagon's revamped TRICARE healthcare system is failing to adequately cover families with special-needs children.
Early this month, several committee members, including House Armed Services Committee Chairman Duncan Hunter, R-Calif., visited troops at Camp Lejeune, N.C. While there, one family told lawmakers recent changes in TRICARE contractors "has made it difficult for large numbers of special needs children to get through," according to Rep. Heather Wilson, R-N.M., one of the lawmakers who visited the base.
Camp Lejeune is home to more than 43,100 troops including Marines and Navy. It also houses 53,545 family members. The base's Exceptional Family Members program is comprised of 750 Marine Corps and 125 Navy families with special-needs children.
At the committee's request, the Defense Department is now investigating the complaint, which congressional sources say could stem from the change in TRICARE contractors.
One source said it is not uncommon for a new contractor to review coverage provided to healthcare beneficiaries, or to make changes. "It's possible that the new contractor is right to review the coverage, because somebody has to be protecting the taxpayer," one congressional source familiar with TRICARE said. "It is also possible that the situation has changed between the contractors, and what was once a medical case has stopped progressing medically and become a custodial care situation."
In these cases, the healthcare contractor could reduce benefits for homecare services that do not require skilled nursing or other medical care.
Although the Pentagon has traditionally been supportive of service members and families with special-needs children, the department is banned by law from providing coverage for such custodial care. Families experiencing changes in their coverage under the new TRICARE system can still receive state-administered benefits through Medicaid. However, such coverage is limited and would be terminated if the military beneficiaries were relocated to another state. "They would have to start all over again with Medicaid in a new state," the congressional source said.
Molly Tuttle, a spokeswoman for Health Net Federal Services, the TRICARE contractor whose region includes military service members and their families at Camp Lejeune, said the company has received no complaints regarding coverage of special-needs children.
"We will have a provider group and a government relations group to look into it," Tuttle said. "But when we changed contracts, we brought the same network from the previous contractor."
Tuttle said the company is working to enhance the existing network by adding providers and in some cases renegotiating reimbursement rates. "I am not aware of anyone not getting their care," she said.
COMMENTS
- I need help now for my boys not later. I have 4 boys -2 live at home all have unknown syndrome/autism. Does nobody know about dis-enrolling from ECHO will increase ABA hours? Also, I am trying to start a case- this continuous non-care when it's suppose to continuous care. We are enrolled in the EFMP- which continuously lose the paperwork & blames each other posts/bases. My husband is stationed over seas & this is the first time in 6 yrs(YES 6 YEARS) that 2 of 3 boys have gotten the center based ABA but bot the recommenced hours. Is anybody else feeling the neglect that am I. You know I'm not the uniform-so there for I'm treated lower than worm poop. Mary Bourgeois Posted August 29, 2009 11:07 AM
- I am EFMP (2003), Tricare Prime (2002), husband active duty (15 years). I have serious disease and injury issues with horrid medical treatment, lack of care, and no doctor who will listen, this has resulted in my having a broken neck/back from disease as well as multiple infections and trips to hospital, and refusal to provide me with known helpful medications. After more abuse over the years, Tricare finally read their own form and saw I have been disabled for quite a few years. Then the bigger nightmare started. A strategic and deliberate tactic by admin. and the clinics to get me out of their way and to avoid any issues they don't feel like handling. This is malpractice and negligence. I don't have proper medication, and have not had even a primary care doctor for years! I am now trying to beg for assistance from private doctors outside of the military who might be kind enough to take my Medicare fight with Tricare, and help me. So far I have not been very successful. None of my bills have been paid by Tricare, even as the 20% payor. Medicare pays immediately and Tricare ignores me. Some of these bills are affecting my personal credit. It is disgusting that my husband just spent over a year in Iraq and spends about 70% deployed in general leaving me sick and alone. The Navy put me in the EFMP to look good but it is a sham, just like Tricare 'benefits'. Meanwhile, my body is breaking down, my health and quality of life are getting worse every day. I have filed paperwork and complaints since 2004 with dozens of people with all departments I can find. Not one person has done anything to help me. It only gets worse. Although recently I was offered some anti-depressants after recent testing revealed 2 torn discs, a herniated disc, gallstones, kidney stones, a possible ulcer, and lab results that are still indicative of the underlying disease process for which they are denying me any medication to treat. Welcome to the life of a military spouse. Barbara Brynjelsen Posted August 23, 2009 6:07 PM
- I am retired from the Army. I see a doctor who only sees adults(18+) my children have had a pediatrician for five years and TriCare has paid when they see him and but now claims my childrens PCP is not the right one and will not pay for a referal to an allergist. They claim my PCP is my childrens. The bill is $1750.00 Charles M. Amerson Posted June 30, 2009 12:41 PM
