New parents connected to the military have relied on Tricare’s breastfeeding support programs for years. Moms have received breast pumps and supplies for free. Now, parents of some infants may also qualify for donor breast milk, too!

Expanding safe feeding options that allow parents a variety of solutions that fit the business of military life is always a good thing. But all this good also comes with a few hiccups.

New Moms Face Snags with Tricare Breastfeeding Changes

While donor milk coverage has been added, the notoriously generous breast pump program has been slapped with new restrictions.

$16 Million Breast Pump Overspend Leads to Major Changes

During a 2018 Inspector General audit, over $16 million in overspending on breast pumps and associated supplies was discovered. In one case, a breast pump that normally cost $200 at major retailers was billed at $1400 to Tricare.

These inflated bills were caused by beneficiaries purchasing a pump directly from a medical supply company, which would then bill Tricare. Another option was to purchase a pump from other retailers on their own, submitting their receipt for reimbursement later.

Now, Tricare is instituting a reimbursement cap and streamlining the process for filing a claim.

Here’s what you need to know now:

• Tricare will reimburse qualified beneficiaries up to $312.84 (CONUS) or $500.55 (OCONUS) during 2019
• There are no restrictions on where beneficiaries may purchase their pump
• Deluxe models are no longer allowed; contact your Tricare call center for specifics
• To get reimbursed for a pump, you must have or obtain a prescription from your PCM or another in-network provider
• Initiate your claim for DD-2642; attach your prescription and a copy of your receipt when submitting the claim
• There are limits on milk collections containers, replacement parts and other associated supplies
• You are limited to one pump per birth event

For questions regarding the specifics of your coverage, please contact your Tricare regional office. You can call Tricare East at 1-800-444-5445 or Tricare West at 1-844-866-9378. Members stationed OCONUS should also call their regional call center.

Canceled Orders, Big Debts

With the major changes to how Tricare handles breast pumps, many beneficiaries have been left up in the air.

As of July, over 5,000 claims were pending at Pumping Essentials. The CA-based company also canceled all current and future orders of pumps and supplies for Tricare beneficiaries.

Pumping Essentials has also officially cut ties, for the time being, with the Pentagon due to outstanding debts owed on already ordered pumps and supplies. In July, the DoD owed Pumping Essentials over $1 million for past orders and claims. Pumping Essentials, in a prepared statement, claims that contractors like Humana and HealthNet were negligent in paying bills on time.

“[The contractors] have drastically mismanaged the handling of these claims, resulting in significant amounts of unpaid claims to Pumping Essentials and many other providers. … At this time, the volume of unpaid claims has put our company in a position where we can no longer sustain the debt that is accruing,” wrote Pumping Essentials officials.

New Benefit, Zero Instructions

Parents of infants with certain medical concerns can now access milk banks with limited or zero cost. But the implementation of this new benefit has been anything but smooth.

Donated milk is used to help totally feed or provide a supplemental food source for infants who meet one or more medically complicating conditions:

• very low birth weight, often due to extreme premature birth
• disorder or surgery that impacts the GI tract
• failure-to-thrive diagnosis
• unable to drink formula, causing weight loss or failure to thrive
• low blood sugar
• heart disease
• organ transplant
• when maternal milk isn’t available and the infant has a serious health concern
• other serious health conditions, at the discretion of the PCM or specialists

Milk banks are located around the country and world, but the extremely high cost has limited or prevented access for many. Donated milk can cost as much as $5 per ounce, with daily bills costing upwards of $150 during peak consumption periods.

Military families have gone deeply into debt trying to care for their new baby. With Tricare’s new policy, retroactive to January 2019, military families will bear less of a financial burden in an already stressful situation.

However, Tricare and the Defense Health Agency announced this new policy without creating or communicating a complete plan of action to providers and associated agencies.

There are questions about what is covered and who is responsible for different elements of using donor milk.

Lactation specialist Pauline Sakamoto said that Mothers’ Milk Bank in San Jose, CA was overwhelmed with calls after the new policy was introduced.

“There continue to be questions as to what the benefit is and what the families are responsible for paying,” Sakamoto said. “For example, shipping costs. Is that part of Tricare coverage or not? And to some extent, Tricare has a co-pay, but we aren’t seeing that families are getting requests. There are a lot of issues right now swarming around this coverage.”

Getting Your Baby Banked Milk

Right now, parents who are interested in exploring how donor milk may benefit their baby should speak to their PCM or medical care team. A prescription is required.

Your child’s doctor should be actively monitoring your baby’s case and writing a new prescription every 30 days. Babies may consume donated breast milk, covered with a prescription, until 12 months of age as long as it is deemed medically necessary.

Parents may need to pay for the donor milk upfront, submitting a claim to Tricare for reimbursement after the fact. With all claims, parents should submit an active prescription and their bill from the milk bank.

In case of confusion, call your Tricare regional call center stateside or overseas. Customer service representatives should be able to help you navigate the billing and reimbursement loopholes.

Have you used either the new breast pump or donor milk benefit? We’d love to hear about your experiences!

EFMP or the Exceptional Family Member Program. It’s supposed to be a program to help military dependents access care, find advocates and only PCS to locations that can really, truly serve their needs.

Except it doesn’t always work that way.

Military spouses hear from commands and MTFs that EFMP will totally help them! It’ll be so much easier to ensure access to the right health care providers, additional support services and education programs (for kids) at wherever they’re stationed.

They hear that it’s “mandatory” to be enrolled.

And then they hear the horror stories from other families, detailing all the things that have gone wrong, promises left unfulfilled and careers derailed.

So what’s the truth about military spouses and EFMP? We went straight to the source – military spouses with EFMP experience that run the gamut.

Digging into Real EFMP Stories from MilSpouses Who’ve Been There

Enrolling in EFMP is supposed to be simple, just some paperwork. Paperwork that you should be able to grab right at your on-base PCM. And your PCM should be helping to determine if you or your children are eligible to begin with.

That’s not always the case, as some military spouses have discovered. Air Force Spouse, Susan R., was given some faulty information

“I should have been enrolled years before, but was told some inaccurate information about EFMP and the population the program serves,” she said. “I was informed by my PCM in 2008, that EFMP was a pediatric program and that adult specialty medical care could always be found. Sadly, that’s not entirely accurate.”

Adults are, in fact, eligible for enrollment in EFMP. But this might not always be clear to your PCM, military or civilian.

Other spouses, like USMC spouse Melissa, were surprised with their EFMP status.

“I had a temporary condition that I did not know qualified me for EFMP, and I was enrolled in EFMP without anyone contacting me or contacting my active-duty spouse,” she explained. “I believe I was enrolled for about two years. When it came time to PCS, we suddenly found out that I was in EFMP, since it came up on the checklists. That was a surprise!”

Unlike Melissa, Susan found enrollment challenging, contrary to the “easy process” touted by the military powers that be.

“Enrolling in EFMP seems to be an easy process, too,” Susan shared. “Fill out a form, get the PCM to fill it out, sign it and that’s it. Sadly, that’s not it. Depending on the diagnosis there could be many physicians and specialists involved needing to fill out and sign paperwork. That process can be long and drawn out.”

Once in “the system,” many military spouses felt let down by the support and services they experienced.

Melissa felt completely ignored by the whole process. Not only was she not informed of her enrollment, she was barely involved in the process to get out.

“I saw a distinct lack of communication from the EFMP service at the base where we were, Melissa said. “I could not believe I’d been signed up and no one from the office contacted me. (It) took him three tries to get to someone who knew what forms we needed to get me out of the program. Then, the final in-person interview we needed to attend was only scheduled through my spouse, not me. He called and asked if I could attend the meeting time. No one from EFMP reached out to me then, either.”

Even though getting into EFMP, and apparently getting out as well, might be a challenge, there are some positives to this program.

“The base we were at had good programs for EFMP members, in terms of regular gatherings and events for both kids and adults,” Melissa said. “I think it was a good program for those who knew they were in it.”

Susan, an Army kid turned Air Force spouse, remembers the days pre-EFMP. In her eyes, the positives come close to balancing out the negatives.

“The positives of EFMP means that families with medical needs are being considered when the service member is up for an assignment,” she said. “I was an Army kid and I remember life as EFMP was being rolled out by the Army. We had families getting stationed in places where their medical, educational and family support needs were never considered. The stress on families was overwhelming. In some cases, rare cases, family members would get very sick and not have the medical care they needed.”

Good & Bad of EFMP

USMC Spouse Jen C. has seen both sides of EFMP. Both Jen and her children are enrolled in EFMP.

“I have been enrolled as EFMP member since 2003. I also am a disabled vet and have physical limitations,” Jen explained. “I had my oldest May 2005. I was given respite. I used respite with the CDC on base. I was given I believe 16 or 20 hours of respite a month. It actually helped our family since my husband was an e-5 and I only had a 10% service connected disability rating at the time.”

Respite care, available to EFMP-enrolled adults to care for their children as well as for EFMP-enrolled children, provides a qualified sitter or care providers. Families then apply for reimbursement at a set rate and for a particular number of hours.

However, after 2009, Jen saw EFMP change – and not for the better in her estimation.

“After 2009 things changed drastically because of the sequestration,” she said. “EFMP respite was than non-existent for EFMP adults.”

Will It Impact the Military Career?

Career issues top the list of why military families try to stay off of EFMP rosters. But if you’re talking to military powers that be, negative career effects are basically non-existent. But what’s the truth?

Actually, it seems like it’s both.

EFMP basically ensures that military families are not moved to locations without the correct services and supports. At least, it’s supposed to prevent that.

In reality, EFMP status can limit duty station options and lead to unaccompanied tours.

Army spouse Megan H. has experienced two unaccompanied tours and denial of tours, all due to EFMP-enrolled dependents. There are multiple EFMP-qualifying individuals in her household.

“(W)e were not just denied accompanied overseas assignments, but CONUS assignments as well,” Megan shared in her personal story. “(The) doctors, without understanding the process, not only ended up putting a wish list of services on each of my daughters’ forms (for now my three oldest all qualified to be enrolled) but they also enrolled me for about six or seven different diagnoses, some of which I didn’t really have, as well as listing approximately seven or eight providers that I needed to see either weekly or monthly for those diagnoses.”

Susan also saw impacts to her spouse’s career. While the personal impact is negative, she can also see the rationale behind the policy.

“(W)e were unable to move to a location that would have helped his career progression. The lack of medical care meant that my family was denied travel to that location. We ended up staying at a location for close to 8 years,” she explained. “I also believe that EFMP is supposed to impact the service member’s career. I’m sure this seems strange, but this is what I believe. If DoD didn’t have EFMP, then families who have children with autism, are diagnosed with cancer, have illnesses that require specialty medical care would move to duty stations and never be able to access the care and services needed.”

A new USMC study appears to show that there is little to no longterm impact on Marine’s careers.

“Not only did we find that career advancement was not distinguishably impacted by EFMP enrollment, we also learned that, on average, EFMP enrollees serve slightly longer than their non-EFMP active duty counterparts, achieve a slightly higher grade, and the majority achieve that high grade in the same or shorter amount of time than the average of their non-enrolled peers,”  said Jennifer Stewart, the EFMP Section Head for Marine and Family Programs.

What Happens If I Don’t Enroll?

If your EFMP-qualifying issue is mild or well-controlled, then this should be listed on your medical paperwork. Opting to avoid enrolling is a 100% personal decision that needs to be based on multiple factors.

However, before choosing to skip EFMP, it’s important to understand the implications.

• Moving to a duty station where limited or no services are provided via MTFs or in-network civilian medical providers
• Being located in a place with limited or no support services, like ABA therapy
• Moving to a location where routine, infrequent maintenance screenings or check-ups are unavailable

Basically, you could be in a place where the things you or your child needs to cope with your diagnosis are just not available. While some diagnoses or individuals might be able to manage, others may not. And you just won’t know what’s there until you get there.

Susan appreciates the fact that her family’s duty station options are more limited.

“My husband and I are good with not being able to move to a location that doesn’t have the medical care to support our family,” she shared. “Our family is the most important thing which means having access to medical care that we need.”

However, Jen found that the system failed her family,

“We had serious waitlist issues in FL,” she explained. “I even called USMC EFMP HQ in Quantico because I asked why they sent me somewhere where there are no services.”

What has been your experience with EFMP? Sound off in the comments!

Here is a recent CNN Headline: “Citizenship will no longer be automatic for children of some US military members living overseas”. Reading this headline; I immediately think, if I am stationed outside the U.S. and have a child are they a U.S. citizen?

All this confusion comes from a Policy Alert, dated August 28, 2019 from the U.S. Citizenship and Immigration Services. Basically it is policy guidance to clarify requirements for residence in statutory provisions related to citizenship regarding children of U.S. government employees and members of the U.S. Armed Forces employed or stationed outside the United States. In layman’s terms, it affects a small number of children who are born to naturalized U.S. citizens who have not lived in the United States for a required period of time.

After realizing this new policy doesn’t affect the majority of military service members and their families who are stationed overseas it did make me wonder how the process works if you have a child while stationed outside the county. There are three ways you can become a U.S. citizen: naturalization which is becoming a citizen after birth, born on U.S. soil or birth to parents who are U.S. citizens. A few things you need to know if having a child outside the country.

• Contrary to popular belief, a U.S. military base outside the country is not considered U.S. soil for citizenship purposes.
• The only way a child born outside of the U.S. can become a citizen is through their parents.
• If your child is born in a military hospital overseas or in a foreign hospital, you will receive a birth certificate but these are not valid for obtaining a U.S. passport.
• It is important that you register the birth with the U.S. embassy or consulate in the country you are stationed in. This requires an application and documents proving the parents’ citizenship as well as the paperwork from the military or foreign hospital recording the birth. You will receive a Consular Report of Birth Abroad which proves your child’s citizenship and is valid for obtaining a U.S. passport

You may wonder if there are any benefits to making your child a dual citizen of the foreign country you are stationed in. This is something that should be carefully considered. Many countries have mandatory military service or income tax that you would not want to inflict on your child. It may make sense if one of the parents were from a foreign country. In these circumstances it would be worth it to speak to an immigration attorney.

An an interesting note this topic came up during the last election regarding whether Sen. Ted Cruz, was eligible to become President because he was born in Canada to a U.S. citizen Mom and a Father who was born in Cuba. He gained citizenship through his Mother and is consider a “natural born” citizen meaning he held citizenship from birth which is the requirement to become President.

Marguerite Cleveland is a freelance writer who specializes in human interest and travel stories. She is a military brat, a veteran and now a military spouse.  Her military experience is vast as the daughter of a Navy man who served as an enlisted sailor and then Naval Officer. She served as an enlisted soldier in the reserves and on active duty, then as an Army Officer. She currently serves as a military spouse. She lives in the Pacific Northwest with her husband and two sons. Visit her website www.PeggyWhereShouldIGo.com

Are you outraged that $3.6 Billion from the Pentagon Budget is going to be diverted to pay for the border wall?

The news has been filled with headlines like this one from a CNN opinion piece “Trump is hurting the military for his own political benefit”. According to the September 3, 2019, DOD Briefing on Use of 2808 MILCON Funds for Construction of the Border Wall, $3.6 billion dollars from the military construction budget will be reallocated to help fund the border wall. I found myself pretty angry for a variety of reasons. One of the listed projects is near where I live affecting one of our military bases and the local economy. The second reason is that budgeting falls under Congress and I didn’t like the use of Executive Orders with President Obama and I don’t like this use with President Trump. It violates our constitution and the separation of powers between the Executive, Legislative and Judicial Branches of the government.

Background. (compiled from the Sept 3, DOD Briefing)

So how can this happen? The president declared a national emergency at the border between Mexico and the United States under the use of Title 10, U.S. Code, Section 2808. The Defense Department then evaluated whether military construction projects (the wall) on the border would support the use of Armed Forces deployed to the border. The chairman of the Joint Chiefs of Staff, Gen. Joseph Dunford concurred that such projects support the use of armed forces. So after all the analysis, Secretary of Defense Esper determined these construction projects are necessary and that the DOD will take on 11 border barrier military construction projects on the border.

Next the DOD identified which construction projects could be deferred with the goal of minimizing the impact within the United States and its territories. They also did not include housing for both troops and families or those that were awarded for 2019.  Approximately $1.8 billion will come from projects outside the U.S. and about $1.8 billion from with the U.S. and its territories.

According to a Military Times article, “Here’s everything the Pentagon is putting on hold to concentrate on building the border wall,” dated Sept. 4. It is quite a few. “In total, the list included 43 projects in 23 states ― two of which had been slated for cancellation ― along with 21 in three U.S. territories and another 63 in 20 partner nations abroad. Now, they are all delayed in favor of 11 new projects that will make up 175 miles of new or reinforced border barriers.”

Where the politics come in – now the DOD is going back to Congress to request these funds that were reallocated to the wall be returned to the Pentagon budget.  In regards to the 63 projects occurring in partner nations, it seems the goal is to ask them to pay for the projects as part of President Trump’s plan to make allies pay a fair share of defense expenses.

Current headlines about money being pulled from the Defense Department to pay for the wall made me very angry. Some even stated that the military would be less safe because of the reduced funding. I found that many of these headlines are very inflammatory and really designed to elicit the response I had. After reviewing all the information I could find and going to the source (Department of Defense briefing about this issue) I realized that the Pentagon has worked to choose construction projects which will have the least impact if they are delayed and I don’t believe any directly affect the safety of our military service members. So, I am still angry that Pentagon money is still going to pay for the wall but it is not a damaging as the headlines would have you believe.

What do you think about this issue? When you see inflammatory headlines do you take them at face value or do you delve into the story a little deeper to find the facts?

Marguerite Cleveland is a freelance writer who specializes in human interest and travel stories. She is a military brat, a veteran and now a military spouse.  Her military experience is vast as the daughter of a Navy man who served as an enlisted sailor and then Naval Officer. She served as an enlisted soldier in the reserves and on active duty, then as an Army Officer. She currently serves as a military spouse. She lives in the Pacific Northwest with her husband and two sons. Visit her website www.PeggyWhereShouldIGo.com

In every single military spouse group, members are constantly discussing Tricare. The ups, the downs and the best tips to make it work for you.

What’s the Deal with Tricare? Common Issues that Every Military Family Might See

Almost every family will run into the same common issues if you spend any time at all dealing with Tricare, MTFs and even civilian in-network providers.

Which Plan Do I Pick?

The first question every military spouse and family encounters is about which plan is best for them.

• Prime: the entirely free (yes, free) plan requires families to default to on-base military treatment facilities (MTFs) and pharmacies, with off-base providers being used when on-base clinics are full. Off-base pharmacies can be used at your discretion, but with a co-pay for medications.
• Select: this works more like a traditional civilian insurance plan, with deductibles and co-pays. But you can see any in-network provider, usually without a referral! However, you may need to pay for services up-front and file a claim for reimbursement later.
• US Family Health Plan: only available in certain areas of the US. Operates like Prime, but with civilian providers. You are not able to access care or the pharmacy on-base, except in the case of an emergency. Referrals for specialty care is provided and there are co-pays for prescriptions and some specialty care.
• Prime Remote: the same exact plan as Prime, but offered to families who live 50 or more miles from an MTF. You’ll see civilian doctors at little to no cost to you.
• Prime Overseas: it’s Prime, but overseas! Get your care on your local military base and grab prescriptions from the military pharmacy. You won’t notice any changes in care, other than your physical location!
• Select Overseas: it’s Select, just overseas! You’ll be able to see providers of your choice, with co-pays and without referrals. Be prepared to pay for services up-front and file claims later. These will be local providers, so there may be a language barrier.
• Prime Remote Overseas: for families located OCONUS but far from an MTF, Prime Remote Overseas is for you! Your care will be managed and coordinated via the contractor’s regional call center.

All plans require enrollment. You can compare the plans before you make your selection.

How Do I Find a Doctor on Prime or USFHP?

Before you enroll, you can check to see where the in-network providers are located. You can read reviews and compare practice specialties.

Pick your PCM (primary care manager) based on your own criteria!

Once you’re enrolled, start seeing the doctor of your choice by coordinating with the Tricare representative and the office.

Where Do I Go In an Emergency?

For something that simply cannot wait, go to the closest ER. Even if it’s not an MTF or in-network provider, just go. Call Tricare or your plan provider network to notify them of your location. This will help them to process any resulting claims.

For anything that is not emergent, you can visit an urgent care clinic. Check the “find a doctor” options available specific to your plan.

Ugh, My Doctor Spends Zero Time with Me

Got a doc who’s in and out ASAP? Make the most of your time and come prepared to get to the heart of the matter.

Bring a list of your top questions and concerns with you. Then go down the list. Having your stuff prioritized means that you can make every second count.

If the limited time is impacting your care or you feel like you’re not being listened to, send a complaint. This helps the powers that be track and address issues within their system. Another option is to ICE the actual facility or doctor you’re working with. This is usually available on your MTFs website.

I Don’t Love My Care Provider

Good news, you can switch providers at any time. Send the request through the Tricare system or call to speak to an operator. You don’t need to give an explanation either.

What If I Want to Switch Plans?

You can change your plan once a year, during the enrollment period in the fall. All other times are off-limits, unless you experience a qualifying life event.

Waiting for Meds Takes Forever

If you’re using the military’s pharmacy, the wait for medication can be long. That’s because active duty troops in uniform get first priority. And because the meds are free, many pharmacies get swamped with prescriptions.

If you’d like to keep using the free pharmacy, go early. There is typically a shorter wait time first thing in the morning. Or scope out your location by visiting and doing recon at different times of the day.

Another choice is to take your prescriptions to an off-base, in-network pharmacy. You’ll be paying a co-pay, but also not waiting.

Finally, you can go mail order. For a co-pay, your routine medication will arrive at your door on a regular schedule.

I’m Not Getting the Care I Need

First, request that second opinion. Then file all the grievances and ICE complaints possible. Let them know you’re upset and detail the reasons why.

Follow up your complaints with in-person visits to the hospital/MTF administrator or care manager. Be ready to explain your concerns calmly and detail the optimal resolution(s).

Remember, you can always switch your PCM at any time. Try that and see if your level of care changes.

Keep requesting to see any specialists you think you need to get a handle on your issue.

And when the next enrollment period swings around, don’t be afraid to change plans entirely.

Mostly, just keep sharing your concerns and be ready to take action in order to get the care you deserve.

How Do I Make Sure My Doctors Follow My Wishes?

Good news, you’re not supposed to get care or treatments without your consent. If you have concerns or questions about a medication, vaccine or procedure, call a halt and start asking your questions!

Ask about alternatives to the initial proposal and why these may or may not be recommended.

While the doctors and nurses are the professionals, you’re the expert in yourself and your kids. Don’t be afraid to take a stand when it matters!

What Are My Recourse Options If Things Go Really Wrong?

First, there is the complaint and grievance procedure. Start there and see where you get.

If they’re not budging, push harder. While the Feres Doctrine bars active duty troops from suing the federal government over medical malpractice, it doesn’t appear to extend to military dependents. Bringing a lawsuit is always a possibility, albeit a very expensive option.

What are your thoughts about Tricare or other military healthcare plans? Sound off in the comments!