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Military Healthcare Pro Tips For Tricare Errors

by Doug Nordman

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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

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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.

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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:

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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.”

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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

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