Military Healthcare Pro Tips For Tricare Errors

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Tricare got me again.

I’ve been retired for nearly 14 years, and I’m a relatively high-functioning veteran who was paid to supervise the operation and maintenance of naval nuclear reactors. I’m pretty good at working with teams and solving problems.

But despite those skills, Tricare (and UnitedHealthcare) have administered yet another beatdown at Hale Nords.

Let me share what I’ve learned so far.

 

The notification letter

Image of logos of UnitedHealthcare and Tricare for a post about how the two companies made a database mistake on my primary care physician. | The-Military-Guide.com

One of these made a mistake– but who?

A couple months ago we received a notification from Tricare that our primary care physician had changed from Dr. B to Dr. K.

I ignored this news because we’ve never actually seen Dr. B. The clinic is a subsidiary of the local university’s medical school, and most of the clinic doctors are residents. I’ve only been there a dozen times over the last 14 years and I’ve always seen a different resident. I love this clinic’s doctors because the residents are still inquisitive and enthusiastic and even a little humble– no attitudes of authoritarian “I’m the doctor” here. I never see the same resident again. They finish their residency and move on, while I might not revisit the clinic for 12-18 months until my next home-improvement accident or exercise injury appointment.

I didn’t care that Dr. B. was replaced by Dr. K. I’d never see Dr. K. anyway.

 

The database error

But unbeknownst to all, Dr. K had the wrong information in the Tricare database. Although he was an authorized primary care physician, he no longer had the proper credentials to practice at “my” clinic and had not updated his Tricare status. If I wanted to see him, I’d have to visit him at his office instead of at my usual clinic.

Nobody from UnitedHealthcare or Tricare or the clinic alerted any of us to this problem because none of us knew there was a problem. The database had merely turned off Dr. B’s authorization (for some reason), automatically re-assigned me to another authorized primary care physician, and spit out a notification letter. I’m not even sure that any of it was ever seen by a human.

Our new problem began very subtly when my spouse tried to get a new pair of contact lenses. She updates her prescription every year or two (we’re both coping with presbyopia) and the Costco optometrist wanted to do an eye exam. The staff told her that they’d request a Tricare waiver for the exam and that she might have to pay for it herself. No big deal, we’ve seen this before.

The optometrist’s staff submitted the usual waiver request. Tricare responded that the physician who’d requested the waiver was not her primary care physician. That was because we’d hadn’t realized that the optometrist needed to change their database from Dr. B. to Dr. K.

While we were trying to sort out that issue, my five-year colonoscopy exam came due. I’m pretty motivated for this one because a small “carcinoid” tumor was found on my appendix (after an emergency appendectomy) and I want to catch any other intestinal problems now. I made an appointment with the clinic for the Tricare colonoscopy referral, which will probably be done at Tripler Army Medical Center. Tripler did my last exam (and my appendectomy) and I only expected to spend five minutes with the clinic doctor to set up my new Tripler appointment.

It’s been over a year since my last doctor’s visit at my clinic, and their front desk seemed to need a long time to figure out my records. The clerk finally confessed that I no longer had a primary care physician there and they couldn’t see me. I mentioned that I’d seen a letter about my PCP being changed because Dr. B. was no longer taking Tricare patients and I’d been switched to Dr. K. That earned me a round of blank stares from the staff. The clinic insisted that Dr. B. was indeed still seeing patients and said that they’d never heard of Dr. K. I persisted, and soon the clinic’s administrative supervisor stepped in. I had questions and she wasn’t interested in solving my problems. I was getting a little intense, and she just wanted me to go away.

There are few things in life more frustrating– and humiliating– than persuading a bureaucrat to approve your request for a colonoscopy referral after Tricare screws up the doctor’s database.

My persuasion was unsuccessful, and I returned home. I was still frustrated and angry, which seemed like a perfect time to get on the phone with UnitedHealthcare.

 

The phone call to customer service

Several years ago, the Tricare contract for the Southwest region changed hands.  It took UnitedHealthcare many years to wrestle the Tricare southwest contract away from TriWest, and the change was not pretty. UHC is extremely conservative about liability and HIPAA requirements, so phone calls to their system go through at least 30 seconds of important educational notifications before you spend another few minutes on the “interactive” voice-response system. They finally seem to have hired enough of TriWest’s former employees staff at the call center and the hold queue was only a few minutes. Of course their computer system and the first representative couldn’t answer the questions so they transferred me to a second rep. I was right in the middle of the call with the second rep when the call dropped with no callback. This seems to be typical UnitedHealthcare customer service.

I’ve dealt with military medical benefits since the 1970s and I’m no longer surprised by these experiences.  At about this point in the UnitedHealthcare conversations, when I’m back in the hold queue again, I usually start looking up flight reservations to Bangkok’s Bumrungrad hospital.  A couple of years ago I learned how good healthcare can be when it’s done right, and now it always seems painful to deal with the American bureaucracy.

Speaking as a nuclear-trained submariner, when I’m blindsided by an error then I want to know that someone not only fixed the problem but also figured out how to keep it from happening again. Those are not the people I talked with at UnitedHealthcare. They couldn’t simply reactivate Dr. B in their system and reassign me to her, let alone figure out what caused the problem in the first place. Instead their script “solves” a problem by re-entering the procedure at the top of the flowchart. It also involves reading me a paragraph of instructions and disclaimers about the 40-mile limit for Tricare Prime. (Because Oahu, my island of residence, is ~44 miles long.) I politely listened along (while checking my frequent-flyer miles for Bangkok) until the rep said “… and so we’ll have to assign you to a doctor in the medical clinic at Schofield Barracks.”

Um, no, “we” weren’t going to do that. I got intense again. Nuclear engineering intense.

Let’s summarize the accountability in this situation:

  • The clinic’s staff swears that it’s not their fault and that the doctor didn’t change anything.
  • Tricare says it’s not their fault that the doctor changed her information.
  • UnitedHealthcare swears it’s not their fault that their system randomly assigned me to a new doctor whose clinic credentials are outdated.
  • And of course UHC & Tricare both seemed to feel that I should restart the assignment process with Schofield Barracks military treatment facility as my default primary care provider– because somehow it’s my fault that they won’t let me use the clinic I’ve had for 14 years.

I liberally applied the phrase “Tricare grievance“.

After a few more minutes on hold while the customer-service staff consulted their supervisor, they managed to assign me to another doctor in “my” clinic.

 

The results

After all of that wasted time, I was finally authorized to schedule the appointment for the referral.  A few days later the doctor examined me and started the referral process.  (In an unrelated surprise, during that visit I turned in a personal record on blood pressure. Instead of my usual 115/70, or my anticipated 145/90, it was 102/51.)  My referral has been approved and I’m awaiting the colonoscopy counseling appointment (next week). But that will probably be an entirely different post.

Ironically, it turns out that Dr. B. might not have done anything to change her Tricare status. She cut back her hours last year, but the clinic staff is still trying to figure out why Tricare (and UnitedHealthcare) have removed her primary care physician credentials.  Nobody has (yet) updated Dr. K’s status.

 

Lessons learned

Now I know to pay attention to any notification that a Tricare primary care physician has changed, and call the clinic to find out why. Every letter from our Tricare provider is important because it might indicate a system error.  That’s especially applicable if we hadn’t done anything to cause Tricare to send a letter.

Another lesson:  ask the Tricare customer service staff whether you should file a grievance to fix whatever problem they created.  And if they can’t fix the problem, then maybe you’ll need to file that grievance.

I hope I get through the rest of the decade without any further lessons.

 

One Sick Vet

Are you a veteran or family member dealing with the healthcare bureaucracy, or wondering why your doctor(s) can’t figure out your symptoms? Take a look at the new blog One Sick Vet.  It’s written by a long-time reader of this blog (and a good friend). They’re a disabled military veteran who lost faith in the healthcare system and decided to explore alternatives. They also know how to use their research skills to “empower themselves through investigation, exploration, and action to live a healthier, more satisfying life.”

 

 

 

 

 

Related articles:
Lifestyles In Financial Independence: Your Mortality
TRICARE Prime premiums and United Healthcare
How To Get Kicked Out Of Tricare
I’m still a Tricare delinquent
40 miles for Tricare Prime — or maybe Tricare Standard
Is Tricare Standard good enough?
Medical tourism at Bangkok’s Bumrungrad Hospital



WHAT I DO: I help you reach financial independence. For free. I retired in 2002 after 20 years in the Navy's submarine force. I wrote "The Military Guide to Financial Independence and Retirement" to share the stories of over 50 other financially independent servicemembers, veterans, and families. All of my writing revenue is donated to military-friendly charities.

7 Comments
  1. Reply
    Doug Nordman February 28, 2016 at 6:54 PM

    Thanks, Richard! Let us know how it works out.

    One Sick Vet, that’s good advice. The Navy has called them Tricare Ombudsmen at their clinics, and they’re essential to cutting through the bureaucracy.

    Deserat, I wish I had an answer for that situation… possibly an advocate, or even a grievance. But that’s nearly impossible to deal with when you’re multiple time zones away.

    Peter, I’ve had the same concierge care experience in Bangkok. It’s tempting to sign up for it in Hawaii, too.

    Vanguard, I wonder if UnitedHealthcare was having a problem with their Hawaii database. I’m glad you got it sorted out!

  2. Reply
    peter gregory February 28, 2016 at 10:08 AM

    The current version of what is called Tricare was more or less built on the architecture of what was called Champus. And that program was designed in the 1970s as a payment reimbursement system for heath care derived apart from the Uniformed, military hospital system. In that sense Champus/Tricare was never really designed as “heath insurance” or healthcare along a civilian Blue Cross/Shield system, for example, that operates either as POS, pay for service option or HMO. It was designed as a cost-share mechanism where folks were reimbursed post the delivery for medical service at a 80/20, 75/25 split. And “Standard” is still how it best operates. The Prime “option” is just that. Beyond the scope of Champus/Tricare to manage or process. It was bulky and remains so, as you more or less have to become your own Heath care organization, fling claims, chasing down MDs, filing paperwork and keeping the system honest. It was never designed to be user or customer friendly. 35 years later, countless billions on the regional contractors, Tricare is like the old Champus Christmas tree with thousands of electrical hook ups and bypasses and one blown fuse from total system collapse. Is “reform” of Tricare the real fix or option, combine all regional contracts into one, throw more money at it? No.

    The best and easiest fix for the DOD and its people in general is for the DOD to get out of the heath care business. Not their line of work and they have no real interest to improve things all that much. Take 3 DOD population groups, under 65 military retired, spouses/family of active duty/retired, mobilized reserve, and move them on to the federal civilian health care matrix, with open seasons and alike, at reduced cost/subsidy. That or turn us all out to the ACA marketplace and fend for yourselves. It’s what we are doing now, with far more administrative hassles than imagined by its planners. As long as people treat or assume Tricare is like or should be health insurance, it is not, and folks only become more angry and upset trying to make their square pegs fit the Tricare round holes.

  3. Reply
    vanguard23 February 27, 2016 at 5:19 PM

    Nords,
    Thanks for sharing your Tricare experience(s)…something I would have to pay closer attention to moving forward. I’ve had to deal with some adjustments with our dental (TRDP) and medical insurance through Tricare, resulting from my wife and I now both retired military (i.e. the dental office contacted MetLife instead of Delta Dental which administers TRDP), but not the same headache that you seemed to have experienced and continue to experience. I can understand your frustration and I would probably blow my top off as well if I had to deal with that. We previously received a letter from Tricare about my wife’s PCM changing from the one I was seeing (we wanted to see the same PCM) to some other PCM who was PA. A call to Tricare followed by a call to our MTF, as well as a visit to the MTF to fill out some paperwork, cleared it up.

  4. Reply
    peter gregory February 27, 2016 at 4:53 AM

    I retired from the Navy in Eastern Pa. Closest MTF is Ft. Dix about 70 miles away, so Tricare as a health care option post service has always been a challenge if I really needed to depend on it. Some would say I am health care “rich” in that I have BC/BS coverage from my bridge career, wife’s a school teacher with her package if wanted, also VA based upon a disability rating, and Tricare. But a benefit is only a benefit if one can access it or use it. My times with Tricare (Heathnet federal) in this region( has been to quote Hobbs) has been nasty, brutish and short due to the bureaucratic complexities of managing different heath care policies, Tricare as last payer in line, getting one bureaucracy to talk to another.

    A few years ago I bought into what is called now concierge medical practice. For 3K a year I see a PCM and his practice as often as needed or wanted, tests, labs, EKGs, blood work ,exams all in house. Never file paperwork or claims, can call and talk to a real human MD in the group, 24/7/365. In essence I have removed the government/DOD/the heath care bureaucracy between myself an primary care, medical access. Should I have to resort to such measures? Shouldn’t heath care for military retirees be free, easy access, or close to it? Is Tricare or any other military health plan a benefit or entitlement of service? All very complex questions. This is what I know. Yes I can afford it , others may not. But is it worth the money for the ease and access of care? Every penny. At 65 I will take TFL/Medicare for spin and see that that works. But this works for now. Sad commentary on the state of affairs? Others will decide.

    As a closing note, anytime life in Aloha State gets old, Berks County Pa. will welcome with open arms. Pa. treats the military retired very, very well. Think of it like Texas or Florida with snow.

  5. Reply
    Deserat February 25, 2016 at 10:33 PM

    Yes, TRICARE has gotten more difficult to deal with. We are aligned with the local MTF, but good luck getting an appointment there. I’ve ended up being referred to/using the local doc-in-box clinic the last two times….and since I (currently the retiree dependent) was overseas for awhile, getting TRICARE to give us the same answer regarding coverage and what needs to be done has been nigh on impossible – literally five different phone calls yielded five different answers.

  6. Reply
    One Sick Vet February 25, 2016 at 12:51 PM

    Good reminder to pay close attention to all Tricare/VA paperwork. I have also experienced multiple Tricare billing errors. I found that local Patient Advocates can be very helpful in straightening out errors – I wandered around the MTF until I found a Patient Advocate, and she made the process much easier. Not only did she straighten out billing errors, the Patient Advocate also ensured I was able to get referrals to specific providers for specialized care. She saved me hours of hassle.

  7. Reply
    Richard Banks February 25, 2016 at 7:45 AM

    Great post on Tricare errors and timely for me as I finished my 3d monthly call with UnitedHealthcare about an allotment issue that they can’t seem to resolve. Keep up the good work!

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