End Tricare Oppression of Military Retirees

I’m a retired Mustang. (For you non-military types, a Mustang is an officer who came up through the ranks.) I enlisted in the Navy in the early 1960s, shortly after the service abandoned “rocks and shoals” for the Uniformed Code of Military Justice (UCMJ). (Again, for you non-Navy types, “Rocks and Shoals” was the relatively arbitrary justice system that preceded the UCMJ.)

My original enlistment contract, which was renewed over the years in one form or another, promised me a regular paycheck, free medical and dental care for the term of my service, free medical care on an availability basis for my dependents, and – if I served for at least twenty years – a monthly check for the rest of my life, free medical and dental on an availability basis for me, and life-long full coverage health insurance with small, affordable co-payments for me and my family.

It seemed like a good deal at the time I enlisted, and over the years of my service, although some of the underlying promises changed, it still seemed pretty good.

I’ve been retired now for about seventeen years. During these years I watched a son grow to maturity and graduate from Annapolis . I lost one wife, and eventually a second. I found myself at times not needing any part of my retirement benefits, and at other times needing all of them just to survive.

The bottom line is: I’ve been there and done that. At one time or another, I have confronted (or been assaulted by) every possible problem within the military retirement health care system – CHAMPUS.

Following my retirement in 1986, CHAMPUS was a simple process. If I got hurt or sick, CHAMPUS paid the bill, while I paid a small co payment. If I could make it to a military health facility (and if they had room for me), it cost me nothing. This seemed a proper fulfillment of my original contract.

It seemed a bit odd to me that while I was earning my full paycheck (before retirement), I didn’t have to make any co-payments – I was fully covered, medical and dental. Then, after retirement and a much smaller monthly check, suddenly I had to pay a significant portion of my medical bill from that smaller check, and there was no dental (unless I wished to wait for months on stand-by list at a military dental facility).

The watchword in Congress was that offering full medical and dental to all retirees simply was not cost-effective. I could do the arithmetic as well as anyone, but what I could not understand was why the defense budget had to be balanced on the backs of military retirees.

Every time I went to the hospital for a medical need, I observed large numbers of people who were receiving full medical care paid for by the same government that forced me to underwrite my own treatments. These people had never served their country; in fact, many were law-breakers or otherwise were a drain on the system I had spend a lifetime defending, such as welfare recipients who use hospital emergency rooms for everything from a runny nose to major problems.

Over the years since the 1960s, CHAMPUS mutated into a fairly complicated system of interlocking benefit plans with names like Tricare Standard, Tricare Extra, and Tricare Prime. Knowing in which plan to enroll is a difficult task for a well-educated, sophisticated person, and a nearly impossible task for anyone else. I like to think of myself as sophisticated and well-educated, but after reading the Tricare Handbook several times over, I still am not sure what each plan is, what each offers, or which I should use.

Over time, it became clear that I was not going to change the system, so I learned to work the system to my best advantage. As I discovered how to maneuver inside the bureaucratic monster called CHAMPUS, I also came to realize that many retirees never developed my ability to handle such a bureaucracy, or possibly simply didn’t have my moxie.

A real-life example will illustrate my point.

After considering all the options, I finally decided to enroll in Tricare Prime. I am not entirely certain why, but it seemed to cost less and offer (possibly) more that the other options. I used a third-party insurance carrier to pay for those expenses not covered by Tricare Prime (deductibles, co-payments, etc.).

Several months ago, I fell and hurt my left elbow. It didn’t appear serious at the time; all I experienced was a bit of pain that came and went. Months later, however, my elbow suddenly began to swell. It happened fairly quickly, and I grew concerned.

Since Tricare Prime requires me to work through a Primary Care Provider, I called up my doctor’s office to make an appointment. Earlier, I would simply have showed up at their Emergent Care Facility, but they had closed this facility a few months before, and I would have had to go to the local hospital for treatment. But, under the terms of Tricare Prime, I could not go to the hospital emergency room without prior authorization unless it was a life or death situation, which this didn’t appear to be.

So I called my Primary Care Physician’s office, waded through the antiquated telephone system, spoke with several receptionists who barely understood English and obviously could have cared less about my problem. I finally got an appointment for two weeks hence – but my swollen, fluid-filled elbow was an immediate problem.

After bullying and pushing for another half hour, I reached a supervisor who told me that I could show up at the office and wait for an opening in my doctor’s schedule. I did, and lost a half-day in the process.

My doctor drained my elbow, prescribed some medications and told me to make an appointment for the following week. When the problem would not clear, she eventually referred me to a specialist who managed to make the swelling go away for a while.

In the meantime, I got billed for the procedures – even though Tricare Prime advertises no billing. Two calls to the regional Tricare contractor and pushing my way through to the supervisor level finally determined that my Primary Care Physician’s office had used the incorrect procedure codes. I notified the doctor’s office, but they would not hear this from me. Finally, I called the Tricare Prime contractor again, forced my way through to a supervisor who called my doctor’s office with instructions for how to complete the paperwork. Several weeks later, the incorrect billing finally disappeared from my bill.

In the meantime, I also received a bill from the specialist. Same problem – same solution, several frustrating weeks later.

When my elbow swelled up again a couple of months later, I revisited the specialist, who recommended I consult with an orthopedic surgeon in the area. He set it up, and I prepared to visit the surgeon’s office.

On a hunch, I decided to call the Tricare Prime contractor about this visit. To my surprise, I discovered that the forthcoming visit was not covered by Tricare Prime. I would have to carry the entire cost myself. When I asked why, they told me that the surgeon was not in the Tricare Prime network. Furthermore, they said that even if he were in the network, I still would need an authorization. When I said that I had received the referral from one of their network physicians, they told me that he was not my Primary Care Physician, and so was not authorized to make such a referral.

The Tricare Prime contractor told me that only my Primary Care Physician could make such referrals. This meant that the specialist had to call my Primary Care Physician’s office, make his recommendation to her staff idiots, and hope that my doctor would call him back for the details. Then my doctor’s staff (the same idiots) would have to set up an appointment with a networked surgeon through his staff idiots who probably couldn’t speak English either.

I then asked to speak with a supervisor. The Tricare Prime contractor telephone clerk told me that a supervisor would call me back. To their credit, I actually received a call several hours later. I suspect my name appeared in their system as a troublemaker who had to be handled immediately to avoid problems. I explained what had happened. This supervisor actually went out of her way to help. She found several network-acceptable orthopedic surgeons in my area, and presented me with a list of who was available, at what days and times.

I thanked her and then I got on my soapbox. I asked this person how she thought it would have been possible for the harried wife of a retired enlisted person with no real concept of how to work the bureaucracy to get the results I had finally obtained. I had chosen to bully and push until I got results. Most people would have given up and either not received the treatment, or paid through the nose for it – even though they were entitled to receive the same service essentially for free.

Men and women who have spent a career putting their lives on the line for the rest of us should not be hassled every time they need medical attention. They should not be subjected to heavy-handed bureaucratic procedures just to get a prescription filled. And especially, the defense budget should not be balanced on their backs.

It is a national disgrace that we supply our service people full medical coverage until the day they retire and walk out the door. And then it’s a hassle to get even the simplest medical procedure accomplished, and it costs the retired members money they no longer have.

There is no reason whatsoever that we cannot put in place a system of health care coverage for our military retirees that allows these people to go to any physician, and have the bill sent to a central location for payment based upon some kind of sliding scale that will accommodate the needs of both patient and provider. No paperwork whatsoever for the retiree, no co-pays, no anything that will stand in the way of full health coverage.

If you have had similar experiences, please relate them to us here at DefenseWatch by emailing them to me at my email address at the end of this article. You may also wish to send copies of this article to your representatives in Congress. If these guys receive a sufficiently large number of complaints, perhaps they will be forced to do something about this disgrace.

It seems that the politicians are counting on military retirees to endure this intolerable situation without complaint, and only a mass revolt by the military retiree community will suffice to put genuine reform of the CHAMPUS Tricare system on Congress’ agenda.

Robert G. Williscroft is DefenseWatch Navy Editor