I ultimately learned through my husband that we could phone a separate agency of Tricare North itself in order to file any complaints about Tricare. He and I did so, to no avail. Since I had no way to record the full name of the representative who spoke with me disrespectfully, all the phone representatives from the regional complaints office did was assure us that there was no reporting mechanism to hold service members accountable for their spouses’ behavior. Our efforts only resulted in more wasted time on both our parts, and anguish for me.
I recently heard from another military spouse, Saundra Gilbert, who also encountered difficulties with Tricare, such as weeks’ long delays in transferring her family between different Tricare regions after a military move; subsequent refusal of both her former and new Tricare office to pay for medical bills; and Congress’ refusal to hold Tricare accountable for reimbursing military families in a timely manner, in addition to many other issues.
One issue that I believe is of special importance is the fact that military family members have no way of knowing how to file complaints on their own, independent of a service member. Saundra, an Army spouse learned from her multiple conversations with Senate, Tricare Congressional Liasons and her husband, that Congressional law forbids militaryfrom distributinginformational pamphlets on how to file complaints within Tricare, without the approval of commanding officers. However, it is procedure that if issues cannot be resolved with Tricare a military dependent may issue a Congressional inquiry or place a direct phone call to local state senators for resolution. The irony is that Senate passes the inquiry to Tricare liasons for them to determine if the issue should be resolved. I would be curious to know how federal policymakers justify that rule – is there some sort of security threat posed by making health care systems for military families accountable to the people they are supposed to support? Is this policy set up to fail in order to save taxpayers money?
Unfortunately, this issue of lack of information and accountability for family members is endemic to military culture. The fact that children and spouses have no voice of their own is a glaring problem in that they are often the ones running the show: a friend of mine recently spent weeks trying to learn the details of her family’s new posts, only to be ignored by the detailer because they wanted to speak to her husband directly. He, unfortunately, was deployed. Regardless of whether or not a service member is deployed, any military family member directly affected by decisions as intimate as health care or the details of a family move should be able to contact the military and its contractors with questions, and have them answered in a timely, respectful, and accurate manner.
Through the communication of sharing our challenges, my desire was for us to be able to share information we gather to benefit each other. As a result, one answer that we have been searching for is Military OneSource. Military OneSource (www.militaryonesource.mil) is a tool for military life questions we didn’t even know to ask. The topics of information include:
- Deployment & Transition
- On Base & Off Base Living
- Education & Employment
- Wellness & Healtcare
- Financial & Legal
- Family & Relationships
- Confidential Assistance
- 24/7 Live Chat or Call Services
Below is a letter that Saundra wrote to Wisconsin Senator Baldwin in April 2017. Fantastically, Saundra comes from corporate America, where she spent decades working on streamlining programs for a Fortune 500 company. Her letter is an excellent example of citizen advocacy detailing how Tricare can better support military families. After experiencing a series of more problems with Tricare, Saundra expanded her improvement solutions to include the below operational ideas.
Issue - Administrative Transfer Takes 30+ Days to go Through System to Change from one Tricare Region to another Tricare Region
Possible Solution - Create Tricare Umbrella Team for Transitioning Families that experience medical issues in transition. This team is responsible for working with regional Tricare plans to ensure payment of all bills are resolved when the family is in transition and that all addresses in medical billing match DERS.
Issue - Soldiers and/or Family Members that have chronic illnesses are not issued an individual case worker thus creating chaos for approvals and payment of insurance forms
Possible Solution - When a soldier or family member is diagnosed with chronic illness or disability, a Case Management Team should be established and an individual Case Manager should be assigned to manage preapproval and insurance payments.
Issue - Forms and Required to Resolve Issues are not Available to Family Members. Additionally, not all programs are made public to all service members and family members.
Possible Solution – Create an online chat or Phone Support Help Desk due to the Soldier being unavailable or because of duty assignment or deployment. This system can also have an option to inquire for information about unknow programs for assistance.
Issue - Issues are not resolved timely when brought to Tricare’s’ attention.
Possible Solution - Develop a more effective Issue Escalation Process limiting the number of times that Tricare can reject the claim without requiring the issue to be escalated to the next level of management for issue resolution.
Require Executive Level Engagement after a certain level of failure of resolution.
Issue - When Insurance is still pending with Tricare, Tricare does not provide the solider or family notification of billing concerns or issues. Family is notified when the medical facility has exhausted all avenues of working with Tricare and turns the billing over to the patient.
Possible Solution - Require that Tricare become more proactive in the payment process notifying the patient of the payment issues as well as contacting the medical facility for medical requirements to process payment.
Issue - “Congressional Policy” doesn’t always make sense and Tricare is the final decision on whether they should pay or not despite escalating to state Senate leaders. Now, Defense Health System only re-evaluates change based on what Tricare leadership brings to the table.
Possible Solution - A help desk should be set up to take the “Congressional Policy” issues that don’t apply in theory. These issues would be escalated to Congress in order to review rather than relying on Tricare to raise the concerns of the users. This help desk could be part of the National Healthcare Reform Committee and their staff or DOD’s Defense Health System.