TRICARE Fertility Care

By Kellie Lunney

July 19, 2012

The rising cost of providing health care to active-duty and retired military personnel continues to be a third-rail political issue. During the past 12 years, the cost of military health care to the government has more than doubled, but Congress does not have the appetite for raising TRICARE fees. At least one provision in the Senate’s fiscal 2013 Defense authorization bill would increase the Pentagon’s health care tab slightly.

Some service members would receive additional coverage for infertility treatments under an amendment offered to the legislation by Sen. Claire McCaskill, D-Mo. The measure would provide fertility preservation services, such as in-vitro fertilization and other types of assisted reproductive technology, to military personnel who have difficulty conceiving children because medical treatment for an illness has caused sterility.

TRICARE currently covers tests for both men and women to identify illnesses or injuries to the reproductive system that could be the cause of infertility, but the insurance does not cover “noncoital” reproductive technologies “except under special circumstances for some severely wounded warriors,” said Austin Camacho, chief of the Pentagon’s benefit information and outreach branch TRICARE management activity.

The Congressional Budget Office estimated that about 1,200 active-duty members would take advantage of the benefit and the additional coverage would increase TRICARE costs by $145 million from 2013 through 2017. Considering the Defense Department’s more than $500 billion annual budget, that’s a drop in the bucket. Still, CBO estimates the services would cost about $15,000 per user, or between $15 million and $35 million annually over the next four years (the costs would increase after the first year).

It’s another cost at a time when many lawmakers, including McCaskill, oppose raising TRICARE enrollment fees, which have stayed relatively flat since the mid-1990s. Active-duty members and their families do not pay such fees, but retired enrollees in TRICARE Prime and their dependents do.

Claiming Lanes

Federal retirement applications aren’t the only claims swimming in a backlog. The Veterans Affairs Department, also struggling to expedite disability claims, plans to launch a new processing model at 16 regional offices this summer.

The idea is to separate claims into three “lanes” once they’re submitted: express, special operations and core. Express claims involve one or two medical conditions and have all the supporting documentation to process them quickly; special ops involve special circumstances, such as financial hardship, homelessness, or serious injury and illness; and core refers to claims with more than two medical conditions or those that need additional evidence to make compensation decisions.

“The segmented-lanes approach helps increase speed and accuracy because the claims specialists become familiar with processing claims of similar complexity,” VA said in a statement.

The department processed 1 million claims during each of the past two fiscal years, but more than 1 million claims were submitted in 2011 and 2010. VA wants to reduce the backlog this year by 100,000 claims in part through the new processing model it is launching. VA’s goal is to process all claims within 125 days with 98 percent accuracy in 2015. The department provides compensation benefits to 3.4 million veterans.

“We have received an unprecedented growth in claims -- nearly 48 percent more than three years ago,” said Allison Hickey, undersecretary of benefits at VA’s Veterans Benefits Administration, testifying Wednesday on Capitol Hill.


By Kellie Lunney

July 19, 2012

http://www.govexec.com/pay-benefits/pay-benefits-watch/2012/07/tricare-fertility-care/56864/