The Army Recruiter’s Wife’s Weblog

Wow! It’s been a while and yet it also seems like time is flying by. So much has been going on. Well, I think from my last post I touched on my Tricare issue I had with the hospital I had planned to deliver at and I’ve been wanting to write about what happened, how it happened, what I did to fix the problem, and so on. So here it goes.

History:

When I first found out I was pregnant back in October I did what you’re supposed to do: made an appointment with my Tricare approved PCM, got a blood test to confirm the pregnancy, and then was referred to an OBGYN for obstetrical care for the duration of my pregnancy. Upon receiving the referral – I called the doctor I had been referred to and discovered that the hospital she delivered at did not take Tricare. No problem – since I had not had an actual appointment with that doctor – all I had to do was find another doctor and call tricare and have the name changed on the referral. Which is what I did. I found a doctor about 5min. from my house and she delivered at a hospital that took Tricare – which was a nice hospital and right across the street from her practice. So, with everything changed and approved by Tricare I started seeing my doctor and my pregnancy progressed.

What Happened:

Fast forward to the second week of March – I went to pre-register and the admissions lady said the financial counselor would contact me to set up an appointment. This struck me as odd. I have Tricare – it’s a good insurance plan – and I’m not supposed to pay for anything because everything is covered under my referral. So, the financial counselor called me and informed me that the hospital no longer had a contract with Tricare (as of March 1st she told me) and that my insurance would only cover 50% of the estimated $34,000.00hospital bill. So, after I freaked out – I called Tricare and found out that indeed the hospital I had planned to deliver at had gone from being an in-network hospital to a Point-of-Serivce hospital – meaning that they went from covering 100% (for prime) to 50%. So, in addition to paying 50% of the hospital bill, I also found out that I would be required to pay a $300 deductible and any expenses that Tricare deemed not medically necessary. Talk about an emotional roller coaster. Pregnancy hormones are bad enough – but then add something like this and it just really rocks your world.

How it Happened:

I have no clue how this happened – I had done everything by the book. I had made sure the hospital took Tricare before I started seeing the OBGYN I had found. Everything was good – I had the referrals I needed and had the green light from Tricare and the hospital. I know I wasn’t to blame – I have been dealing with Tricare since I was 18 – and had never, ever, ever ran into this problem before.

What I Did to FIX the Problem:

I’ll admit it, the first thing I did was cry. I cried A LOT!! But, once I got it out – I was able to figure out what I needed to do and get it done WITHOUT my emotions getting the best of me. First, my husband and I talked about it and decided that 1) we don’t have over 15grand sitting in our bank account to cover the cost of the delivery (despite the awesome tax write off that would’ve been), and 2)he doesn’t work his butt off for medical benefits for us to not put them to use so we don’t have to pay anything when our benefits are supposed to cover something 100%. So, the decision was made – we had to find another hospital. I spoke with my doctor and unfortunately – the only other hospital she delivered at in the area did not take Tricare, which left me with no other choice than to change doctors at 31weeks into my pregnancy. It was tough, it sucked, and I had the HARDEST time finding a doctor in this area that would take me at 31 weeks. The first thing I did in my search for a new OBGYN was to find a hospital that took Tricare – luckily I found 2. So from there I cross referenced the hospital lists with the list Tricare had and then I started making phone calls. I finally found a doctor (that took Tricare) and would deliver my baby at a hospital that took Tricare. Talk about a pain in the butt!

My Thoughts, Observations, etc.:

I wish I could say that my experience was a fluke. But, sadly, it isn’t. I know now that I am not the first that this has happened to and I won’t be the last. I know in our area, as the cost of healthcare is rising (and this state’s budget is out of control) I think that hospitals are demanding more and more money for their services from insurance companies to balance out with the lack of money coming in from state paid for health insurance. Not to mention, the thing I hear the most from my doctors here is that Tricare just isn’t competitive with the amounts they pay for services and at times they make it difficult to get reimbursed. Of course, since I’ve been here most people look at my military ID like it’s in Greek and almost always put my social instead of my husbands on billing forms. (When I went to pre-register at my new hospital I handed the lady my ID card and she asked me if it was a real identification card – when I told her yes – she said she had to ask her supervisor to make sure she could take it. They came back and wanted my drivers license as well – just in case – and we’re shocked that it was out-of-state and said I might have to go get an in-state one. I told them that that wasn’t going to happen and my ID’s I gave them were just fine.)

It’s frustrating – living out on the fringe of the Army and having to deal with some of these issues. I don’t mind calling Tricare when I have a question – the number is actually on my speed dial – but I think that Tricare needs to make an effort to provide us recruiting families with a more readily available access to healthcare in our region. That means keeping contracts with hospitals in areas, updating information on their page regularly, and providing us with more options. I will be the first to admit – here in California there is a difference in the hospitals around here. I don’t want to sound classicist – but dammit – my husband works hard and I don’t want to go to a hospital that generally serves a low-income population because that’s all that TriCare could afford to get a contract with. I want health care comparable to what I would receive at an MTF (like Womack, Tripler, Brooke AMC, and/or other mid-sized MTF’s) within a reasonable driving time frame and distance. I don’t need to go to a top-of-the line, Hollywood-esque hospital either – where the doctors all have their own reality shows and product lines – but somewhere in the middle between good and excellent without the hassle of having to be my own insurance advocate. It’s tough enough being the advocate for my healthcare and the healthcare of my family – I don’t want to be my own insurance advocate and have to take my Tricare handbook with me whenever I go to my first office consultation with a doctor.