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How Tricare’s Pharmacy Provider Change Impacts Your Prescriptions

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On December 1, 2016, Tricare removed CVS, including CVS inside Target, from the Tricare retail pharmacy network and added Walgreens and Kroger.

That means that if you currently fill your prescription at CVS, you will need to move your prescription to another network pharmacy or pay full price for that medication.

You have options when it comes to filling a prescription. If you are one of the numerous beneficiaries that need to move your prescription, consider these options when switching.

Military Pharmacies

You can have your prescription filled at a military treatment facility. There is no change to military pharmacies at this time. Medication can to be filled at military treatment facilities free of charge. Call the closest one to you to see if they have the medication you need on hand.

Civilian Pharmacies

If you choose to fill prescriptions out in town, Tricare recommends Walmart, Rite Aid, Walgreens and Kroger as the largest pharmacies with the ability to obtain specialty medication. There are more than 58,000 retail pharmacies in network. This includes other national chains as well as pharmacies in grocery stores and independent pharmacies that you can fill your prescriptions at.

TRICARE Pharmacy Home Delivery

If you have maintenance medications, medicine that you take regularly, it is free to use the Tricare pharmacy home delivery system. You can order prescriptions online, over the phone or through the mail.

Even if you choose to have an initial prescription filled at a military treatment facility, you can still have the refills sent through Tricare home delivery.

A patient care advocate will contact your doctor if you need help getting your prescription transferred. Through Tricare pharmacy home delivery, you will receive a 90-day supply of your medication. Tricare recommends that you have 30 days of medicine before ordering to ensure there is plenty of time to get you properly put into the system and that the medication arrives before you run out.

Ordering your medication through Tricare pharmacy home delivery has many benefits including: automatic refills, free delivery, free generics and the option to talk to a pharmacist at any time.

Saving money is another benefit. As of February 2016, generic medications carry a $30 retail network co-payment, while home delivery does not have one at all. Formulary brand medications filled at retail network pharmacies have a $72 copay as opposed to $20 through Tricare home delivery. Non-formulary medications could cost you $150 at a retail network pharmacy, but would only be $49 through home delivery. These prices reflect a 3-month supply of medication.

Getting Reimbursed When Using Non-Network Pharmacies

If you choose to fill your prescription at a non-network pharmacy, you will be required to pay the entire price of the medication up-front. You then file a claim to get a reimbursement. The amount you get back however depends on your status and Tricare plan.

Active duty service members will receive complete reimbursement.

Dependents on Tricare Prime will get 50% of the cost share back.

Those on any other Tricare plans can expect to pay $24 or 20% of the cost, whichever one is higher, for formulary drugs. This is only after you have met your annual deductible.

If you are filling a non-formulary prescription, you will pay $50 or 20% of the cost, whichever is higher, after meeting your annual deductible.

Claims must be filed within one year of filling the prescription at a non-network pharmacy. Through Tricare’s website, you can access the Patient’s Request for Medial Payment (DD Form 2642), which you will need to fill out and mail in.

How to Transfer Your Prescription

Transferring your prescription is easy. You simply take your prescription bottles to a new pharmacy and have them call your previous pharmacy or you can call a new pharmacy and ask them to contact your old pharmacy.

Another option is to contact your doctor and ask them to send a prescription to your new pharmacy. You can also call Tricare home delivery (855-778-1417) to see if they carry your medication and then have it delivered to you.

Final Key Points to Know

There are no other changes to the Tricare Retail Network. If you do not currently fill your prescriptions at CVS, including CVS inside Target, then you do not need to change anything with your prescriptions. There is no change to Tricare copays.

There is no grace period. If you fill a prescription at CVS after December 1, 2016, you will pay for the entire medication and then need to fill out a reimbursement form.

To learn more about Tricare’s changes to the pharmacy provider list, click here.

Your Guide to Your Tricare Vision Benefits

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Did you know that Tricare offers vision benefits? If you have been avoiding having your eyes examined because you thought it would cost too much or you didn’t know what Tricare covered, this article is for you. We laid out the Tricare vision benefits for you.

Your Guide to Your Tricare Vision Benefits

What are your questions regarding Tricare vision benefits?

Tricare vision benefits vary based on your status: active duty, reservist, retired, military spouse or child of active duty, reservist or retired service member. Depending on the type of Tricare plan you have also makes a difference: Tricare Standard, Tricare Prime, Tricare Remote or Tricare for Life. Once you know which Tricare program you fall under, you can easily see what your options are.

What’s covered by Tricare?

Eye Exams

For the most part, Tricare covers routine eye exams. Those on active duty can have as many eye exams as needed to make sure they are fit to continue working.

The families of active duty service members can have an eye exam conducted once a year.

All other Tricare Prime beneficiaries are covered for an eye exam every 2 years. This includes retirees and their families. If however, the patient has diabetes, they can have their eyes examined once a year.

Tricare has a benefit called Well-child Care. Eye exams for children ages 3 to 6 are covered for an eye exam every 2 years at no cost, no matter which Tricare plan they fall under. These exams can also incorporate screening for amblyopia and strabismus.

Tricare Standard and Extra along with Tricare Prime and Tricare Prime Remote beneficiaries can have their eyes examined from any Tricare authorized provider. If they are a network provider, no referral is needed.

If you choose a non-network provider and you don’t get a referral from you PCM, you can find an optometrist in their point of service system. You will face a cost share however.

Glasses and Contacts

All active duty service members, including Guard and Reserve that are activated, are permitted one pair of standard issue glasses and one pair of sunglasses as well as one pair of glasses of their choice from a military hospital or clinic. These can also be ordered through the Navy Ophthalmic Support Training Activity Command. All non-activated Guard and Reserve members will have their glasses ordered through this system. If they become activated, they will receive the same glasses as active duty service members. Retired service members can also order their glasses through this system.

Tricare does not cover glasses or contacts for dependents except for those with specific diagnoses. This includes treating infantile glaucoma, corneal or scleral lenses for treatment of keratoconus and scleral lenses are also available to those that do not have normal tearing. Intraocular lenses, as well as contacts and glasses are available for those that suffer with loss of human lens function after intraocular surgery, ocular injury or congenital absence. Pinhole glasses are covered after surgery is performed for a detached retina.

Eye Surgery and Treatment

Tricare beneficiaries are covered for most eye surgeries as well as eye treatments. It does not cover everything however.

Tricare does not cover the following eye treatments:

  • refractive corneal surgery
  • orthokeratology
  • orthoptics vision therapy
  • eye exercises
  • eye therapy
  • epikeratophakia or intraocular lenses for correcting astigmatism
  • presbyopia

It also does not cover canaloplasty for the treatment of glaucoma or autologous serum eye drops.

Now that you know what is covered by the Tricare vision benefits, make an appointment to have your eyes examined. Make sure to schedule an appointment for your children as well.

To learn more about the Tricare vision benefits, visit the Tricare vision webpage.

Tricare: 2 Urgent Care Visits Without a Referral

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Tricare began an Urgent Care pilot program on May 23, 2016, that extends through May 23, 2019. It allows Tricare Prime, Tricare Prime Remote or Tricare Young Adult-Prime members in the United States to visit Urgent Care facilities twice a year without a referral from a primary care manager (PCM).

Previously, these beneficiaries were required to have a referral from a PCM within 24 hours of going to an Urgent Care facility.

The pilot program allows Tricare beneficiaries to make 2 visits to Urgent Care within each fiscal year, which is October 1 through September 30.

You can now seek help from any Tricare authorized provider. An authorized provider is one that is licensed by a state, accredited by a national organization or meets other standards and is certified to provide benefits under Tricare. These providers are categorized as either network or non-network providers.

If you do receive a referral from your PCM, it does not count against the 2 Urgent Care visits that do not require a referral. If the nurse advice line tells you to go to Urgent Care, it also does not count against your 2 visits per fiscal year.

Tricare Allows 2 Urgent Care Visits Without a Referral

Tricare is trying out a new policy that allows certain Tricare beneficiaries to utilize Urgent Care facilities without a referral from a PCM.

What is Urgent Care?

If you need medical attention within 24 hours and cannot be seen by your PCM in that time, you need Urgent Care. Some examples of why you might need Urgent Care include: treatment for high fevers, sprains such as your wrist, illness that hinders proper breathing (croup), potential concussion from a fall or other urgent matters that do not threaten life, limb or eyesight.

If an injury does threaten life, limb or eyesight, that is considered an emergency. In that case, you would go to an emergency room.

If you are unsure if your illness requires emergency care, urgent care or simply a scheduled appointment with your PCM, you can call the Tricare nurse advice line at 1-800-Tricare. It is available 24 hours a day, 7 days a week.

What type of Urgent Care providers can you see?

You can see both network and non-network Urgent Care providers. Simply make an appointment or walk in to their facility. There are many different types of Urgent Care providers, all of which are approved for you to visit. These include:

  • Family practice
  • Internal medicine
  • General practice
  • Pediatrician
  • Obstetrician/Gynecologist
  • Urgent Care Clinic/Convenient Care Center
  • Physician Assistant
  • Nurse Practitioner
  • Certified Nurse Midwife

While you are authorized to visit these Urgent Care facilities, you may still have to pay network copayments. Visit the Tricare copayments site to determine if this applies to you. Although you do not need a referral to go to these Urgent Care locations, you still need to inform your PCM about the care you received. You may also need to schedule a follow-up appointment.

Who is eligible for this pilot program?

All active duty service members in Tricare Prime Remote, activated Guard/Reserve members in Prime Remote and all other beneficiaries enrolled in Tricare Prime, Tricare Prime Remote or Tricare Young Adult Prime can take advantage of this pilot program.

If however, the active duty service member, Guard or Reserve member is enrolled in Tricare Prime, they are not eligible. All beneficiaries enrolled in the U.S. Family Health Plan as well as those families enrolled overseas are not eligible. Those traveling in the United States who are enrolled overseas still do not need a referral from their PCM, they simply are not limited to 2 visits to an Urgent Care facility. Any care received overseas does not count as well.

If eligible beneficiaries exceed more than 2 Urgent Care visits within a fiscal year, they will be required to get a referral from their PCM or will be charged a point-of-service fee. You can avoid this fee by calling the nurse line before going to an Urgent Care facility.

What do you think about Tricare changing this policy for Prime beneficiaries? When have you used Urgent Care?

Mental Health Resources for Military Spouses

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Military life can be fun and exciting as you explore the world. Moving from place to place gives you the opportunity to have new adventures, try new things, make new friends and learn new things.

Military life also can be overwhelming, lonely, difficult and hard to handle. Sometimes it can be a little too much.

Mental Health Resources for Military Spouses

There are many mental health resources available to military spouses. You don’t need to suffer in silence. Help is only a phone call away.

Making friends and forming deep connections with fellow military spouses can truly be life saving. They can help you through tough times and help turn the tides sometimes.

Everything can’t always be fixed with a friend though.

Maybe you don’t want to admit to anyone how you are really feeling or maybe they don’t understand. No matter the reason, if you feel like you need someone to talk to, there are mental health resources available for military spouses.

You aren’t alone. Help is only a phone call away.

Here is a list of available mental health resources for military spouses:

National Military Family Association

There are many options to choose from when you are ready to take that step. The National Military Family Association is a wonderful organization founded by military spouses that advocates for military families. There are mental health resources listed on their site to guide you to the proper avenue that will get you the care you need. This can range from short-term counseling and assistance to long-term or medical mental health assistance.

Non-medical help can be sought out from family support centers at your installation, through the office of the chaplain, at military hospitals and clinics as well as through military family life consultants.

Military OneSource

Military OneSource offers non-medical counseling sessions as well. Through Military OneSource, you are entitled to 12 free sessions. These sessions can be in person, over the phone or online. To find out more and to make an appointment call 1-800-342-9647.

Tricare

Long-term medical and mental health resources are available through Tricare. You can visit a mental health care provider at a military hospital or clinic or utilize the Tricare network for authorized civilian mental health resources. The cost associated with these services will depend on the type of policy you have with Tricare, Prime or Standard.

Military spouses can receive up to 8 outpatient mental health care visits without needing a referral. If follow-up appointments are needed, you will be required to get a referral from your provider. Visit Tricare’s website to learn more.

There is unfortunately a stigma that comes with mental health in this country. Sadly, many people are afraid to seek help because they fear there may be consequences once it’s known that mental health resources are needed.

In the military community, there is the fear that it will have an impact on promotions and duty assignments. If you feel like something isn’t right, like you just aren’t yourself, don’t keep it bottled up for fear of repercussions.

You don’t have to go through official channels, like Tricare, initially if that’s what’s holding you back on seeking help. There are many anonymous platforms you can use for mental health resources.

Military OneSource Confidential Help

Free confidential consultations and services are offered. If you want to talk to someone they offer in person, over the phone, online and secure video chat. They can help with emotional and interpersonal difficulties to include adjusting to military life, surviving deployments, everyday stress, parenting challenges and working though loss. The counselor will not inform anyone, including the command and your spouse, of your consultation.

DSTRESS LINE

The Marine Corps DSTRESS Line is available 24/7 and is an anonymous phone and chat counseling service available to veteran Marines, attached sailors and family members. It is manned by veteran Marines, Marine Corps spouses and licensed behavioral health clinical counselors that have Marine Corps specific training. The phone number is 1-877-476-7734.

National Guard Joint Services Support

The National Guard Psychological Health Program has directors of psychological health in every state, territory and online to help family members get the help they need. They have programs to build family resiliency, educational support for complete wellness and access to immediate help. They also have an online library where you can research mental health.

Family Advocacy Program

This mental health resource is for service members and their families. They help with issues stemming from deployment and life stressors that cause problems with family function, domestic violence and child abuse. Classes, workshops, counseling and new parent support programs are all available.

There are many options available to military spouses when mental health resources are needed. The first step is to admit to yourself that you need help and that that is OK. You can start by talking to a friend, a family member, a command spouse liaison or your doctor. If they can’t provide the support you need, take the next step and seek professional help through mental health resources such as these listed above.

Did we miss any mental health resources for military spouses that you recommend? Tell us in the comments section.

What You Need to Know About the VLER Health Information Exchange Initiative

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The Virtual Lifetime Electronic Record (VLER) Health Information Exchange Initiative was formed following President Barack Obama’s remarks on April 9, 2009. The focus of his speech was to outline improvements to the health care system for veterans.

At the time, there wasn’t a system in place that connected a service member’s record from the Department of Defense (DoD) to the Department of Veterans Affairs (VA) for treatment and care. However, during the President’s remarks, he called out the DoD and VA because they,

“have taken a first step towards creating one unified lifetime electronic health record for members of our armed services that will contain their administrative and medical information – from the day they first enlist to the day that they are laid to rest.”

Now, the VLER Health Information Exchange is currently in use for veterans.

Veterans can have their comprehensive medical record all in one place, so VA health facilities and participating health care providers are able to access applicable medical histories.

What Veterans Need to Know About the VLER Health Information Exchange Initative

Have you heard about the VLER Health Information Exchange? What questions or concerns do you have about it?

I was recently chatting with a nurse friend about the VLER Health Information Exchange. The concept is great and really does allow for a streamlined approach for both veterans and health care providers as long as health care providers are privy to the system. She was telling me there is a disconnect with Military Treatment Facilities (MTF) and the VA.

For example, if a veteran wants to seek treatment at a military hospital, he or she still may need to carry all of their documents to show their medical history from the VA to the MTF. Currently, the systems aren’t “connected” per se. The disconnect could lead to delays in treatment and lost messaging.

That will change on June 1, 2016, when the VLER Health Information Exchange will expand to the Tricare network.

The overall goal is to connect the health care providers that serve military members and their families to their medical record, including lab results, allergies, medications and illness. It would take away the need to carry paper records when you visit a health clinic.

After it was explained to me by my friend, I thought of it as a bridge system that carries accurate information to the appropriate health care provider. Whether you are being treated at a VA facility for one ailment or getting a general check-up at a MTF, your doctors are on the same page to make the smartest diagnosis and care.

Tricare released a handy video that also explains the VLER Health Information Exchange and what it means to military members. The key takeaways from the VLER Health Information Exchange video is that the system is secure, efficient and effective.

It’s secure because only authorized health care providers can access the information. Tricare lists the providers that can see your record as military hospitals and clinics, VA facilities and civilian groups that are part of the eHealth Exchange. From the site, “the eHealth Exchange is a network of exchange partners who securely share clinical information across the United States.”

Efficiency comes into play because the VLER Health Information Exchange would avoid any cross duplication of tests and/or procedures already done for a patient. Because it is a comprehensive health record of an individual, the health care team can assess your current situation to give you appropriate treatment, which highlights effectiveness.

Of course, veterans and family members could opt out of the system. It’s not required to participate, but that would mean none of your medical history will be on the VLER Health Information Exchange. Currently, active duty members must be a part of the program.

Take a look at Tricare’s VLER Health Information Exchange resource site to read more about the initiative to see if it’s something you would want to use or if you would rather opt out of it.

Do you have any questions about the VLER Health Information Exchange? Share them in the comments section.

Tricare Covers Breast Pumps at No Cost for New Mothers

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It was 7 years ago when I walked into the Tricare representative’s office at the Naval hospital in Okinawa and asked this question:

How can I get a breast pump?

At the time I was pregnant with my oldest and stationed in Japan. My civilian friends who had recently had babies told me to save my money and to not buy a breast pump. Their insurance companies paid for their breast pumps and surely, Tricare would pay for mine.

Negative.

The Tricare rep kindly explained to me that no, at that time, Tricare didn’t cover breast pumps. I was disappointed (especially considering how many military couples were having 2-baby tours on Okinawa), but accepted the policy.

Since then Tricare has changed their policy.

Tricare now covers breast pumps and breast pump supplies for new mothers who have a prescription from a Tricare-authorized physician, physician assistant, nurse practitioner or nurse midwife. This policy went into effect in July 2015.

This policy change is also retroactive, so if you purchased a breast pump since December 19, 2014, you can submit a claim for reimbursement.

How do I get Tricare to pay for my breast pump?

The first step is to get a prescription.

This prescription must be from a Tricare-authorized health care provider. See the list above. Make a copy of your prescription for your records. Your prescription shouldn’t be for a specific manufacturer, brand or model number, but it must show if you’re getting a basic manual or standard electric pump, according to the Tricare guidelines.

If you qualify for a hospital-grade pump, Tricare advises that you work with your provider and your regional contractor to get a referral and authorization.

Once you get your prescription, the next step is to decide how you plan to get your breast pump.

The Tricare guidelines said “If you don’t want to pay up front, contact your regional contractor to find a network provider or supplier. You need to show your prescription.” In this case, you won’t need to file a claim.

If you are willing and able to pay for your breast pump upfront, you can buy it from any breast pump supplier. There isn’t a list of approved providers. That means you can buy it from any of the following:

  • Post Exchange (PX), Base Exchange (BX), or Station Exchange run by the The Army/Air Force Exchange Service (AAFES); The Department of the Navy; The United States Marine Corps; or The United States Coast Guard
  • Civilian stateside and overseas retail stores (such as Walmart, Target, Babies”R”Us, CVS)
  • Online store (such as Amazon.com, Overstock.com; standard shipping and handling is covered)

You won’t need to show your prescription at the time of purchase. Make a copy of your receipt and save it. You’ll need it when you file your claim for reimbursement.

Let’s say you choose to get your breast pump through a military clinic or hospital, then simply follow their procedures.

How do you file a claim for your breast pump?

For those of you who plan to buy a pump or have paid for one out-of-pocket since December 19, 2014, complete a DD Form 2642, attach a copy of your prescription and receipt and then mail it to your Tricare claims processor. Your reimbursement check is mailed to you.

Besides breast pumps, the policy also includes breast pump supplies. You can get these items before or after delivery. Here is a list of what is covered:

  • Standard power adapters
  • Tubing and tubing adaptors
  • Locking rings
  • Bottles (that are used with the breast pump, not regular baby bottles)
  • Bottle caps
  • Shield/splash protectors
  • Storage bags

Tricare doesn’t pay for extra breast pump batteries, nursing bras, over-the-counter creams, ointments and other products that relieve breastfeeding-related symptoms or breast pump cleaning supplies.

This policy applies to all Tricare-eligible female beneficiaries. It is available to you no matter which Tricare plan you use (Tricare Prime, Standard, Reserve Select, U.S. Family Health Plan, etc.) or your sponsor’s status (active, retired or Guard/Reserve).

Tricare covers one breast pump per birth event. If you received a breast pump when you were pregnant last year and you are pregnant again, you can get a new breast pump.

What questions do you have about getting a breast pump through Tricare?

Is the Military an Easy Target for Budget Cuts?

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Oh, budget cuts. We military families cringe when we hear that in association with the military. Why do we see these cuts happen and why do they have to hurt so much? Why is cutting Tricare, housing and other benefits the best way to handle the budget?

Is the Military an Easy Target for Budget Cuts?

The truth is, only 1 percent are serving and because of that, a lot of people don’t understand what we need.

I have been a military spouse for more than 10 years now and I have seen plenty of other ways to cut the budget instead of cutting where it hurts the most. That makes me wonder, why is the military an easy target for budget cuts?

One reader wrote this in a comment about proposed changes to the commissaries:

This is a reduction in benefits any way you look at it. Another pay cut. The military is an easy target since they aren’t allowed to be political.

Is this true? Is the military an easy target for cuts because the military is not allowed to be political? I think there is some truth to this but it isn’t the main reason.

The biggest reason is because few people in the government have a real connection to the military. You are more likely to make cuts to something you think that a small percentage of the population will actually be affected by.

Although military members themselves can not be political, others who are associated with the military and who care just as much can be. Spouses and those who have served in the past. Those with children serving or with parents who have served. They are people who can get political about the cuts.

Because of this, there has to be more to the cuts than just the fact that those who serve can’t be political.

When my husband joined the military, we didn’t know too many people who were also making that choice. Over the years that has changed as we have met more and more military families. However, when we go home we still feel like the minority when it comes to the military. This isn’t true for everyone of course. Others come from big military communities and have known the military life before they became a part of the service themselves.

The truth is, only 1 percent are serving and because of that, a lot of people don’t understand what we need. They don’t understand that when you sign up to fight for your country, you expect your family to be taken care of in return. That you shouldn’t have to worry that your health care will be cut, that services for your special needs kids will suddenly be taken away or that you have to worry that you will not make enough each month to support them.

If we could figure out a way to make sure everyone with the power to change this knows what military families need and what we don’t, things might change. If they could hear the voices of the military spouses and other family members, maybe they would find another way to make their cuts. If they could truly understand what the budget cuts do to the 1 percent serving in the military, maybe they would do something else.

This means that change needs to come from us, those that stand behind those serving in the military. We need to be aware of the changes that are being made and do what we can to stand up against them. This won’t always be easy and sometimes things will feel like we are not even making a difference, but the more people understand what military families need, the better chance we have for things to change.

Do you agree with that statement the “military is an easy target since they aren’t allowed to be political?” Why or why not?

Tricare Dental Contract Change

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More than 1.8 million beneficiaries will see a change in their dental coverage next year as the government has just awarded United Concordia Companies, Inc. Tricare’s dental contract.

MetLife has held the contract since they took it over from United Concordia in 2012. Now that the government has made the switch back, there is plenty of protest.

How the Tricare Dental Contract Change May Affect Your Dental Care

If you’re worried about scheduling your next cleaning, note that United Concordia doesn’t take over Tricare dental until February 1, 2017.

The contract award is for $11,010,000 to support the Tricare Dental Program by providing comprehensive dental care services around the world to eligible Tricare beneficiaries. There were 4 offers made, but ultimately the Department of Defense (DoD) went with United Concordia. The 5-year contract includes 1-year transition in contract with 5 12-month option periods and a 12-month phase out period. United Concordia already manages the Tricare Active Duty Dental Program (ADDP) for active duty service members.

United Concordia reports that surveys confirm that enrolled members and the government are both satisfied with their service.

Some beneficiaries however are skeptical of the change.

When the DoD awarded the Tricare Dental Program contract to MetLife in 2012, many were delighted to find dental coverage expanded in many categories. The annual maximum amount covered increased, the lifetime orthodontic coverage increased, there was an addition of accidental dental injury and pregnant women were allowed an extra cleaning.

Now there is worry that some of these additions won’t carry over.

If United Concordia does keep these category expansions going, the question then becomes how much will this cost? A company spokesperson said that they don’t have specifics on Tricare dental coverage yet as they are still working out details with the government. In turn, the DoD says it cannot comment until the protests have been settled. That leaves a lot of room for questions and wondering minds.

A few program details have been announced however. The annual maximum benefit will increase from $1,300 to $1,500 under the new contract. Sealants, which required a 20 percent cost share under MetLife’s management, will now be completely covered with no out-of-pocket costs at all.

Monthly premiums won’t be going away though. All beneficiaries who are currently required to pay a monthly premium will still incur that cost. Two free cleanings a year will continue to be the norm and pregnant women will be able to have a third cleaning.

How the Tricare Dental Contract Change May Affect Your Dental Care

Is your family enrolled in the Tricare Dental Program?

While these benefits are all great, some worry that they will have to find a new dental provider once the change in contract occurs. Each dental office can choose which provider they accept for dental coverage and they might not accept Tricare under United Concordia. It can be nerve-racking enough going to a dentist. Once you find one you like and trust, whether for yourself or your family, you want to stick with them. Facing the potential to have to search for a new dental office is cumbersome.

If you’re worried about scheduling your next cleaning, note that United Concordia doesn’t take over Tricare dental until February 1, 2017, so you have plenty of time to see your dental care provider.

If you or a family member are not enrolled in the Tricare Dental Program and would like to do so, you can sign up online.

The Tricare Dental Program is the world’s largest voluntary dental program. Those eligible for enrollment include: family members of active duty service members, family members of national guard/reserve members, and national guard/reserve members who are not on active duty or covered by Transitional Assistance Management Program (TAMP).

Coverage is available worldwide. It includes coverage for many dental procedures including:

  • exams
  • cleanings
  • fluorides
  • sealants
  • X-rays
  • fillings
  • root canals
  • gum surgery and tooth extractions
  • crowns
  • dentures
  • orthodontics and braces
  • scaling and root planning for diabetics
  • as well as an additional cleaning for pregnant women.

If you’re worried about how the Tricare Dental Program will change after the contact award, don’t delay in making a trip to your favorite dentist before next year.

How do you feel about United Concordia being awarded Tricare’s dental contract?

10 Reasons MilSpouses Don’t Ask for Help

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Asking for help is never easy and for some reason we military spouses have trouble with doing so. Especially when we really need the help. We try to do everything ourselves and don’t think we should stop and ask anyone for anything.

10 Reasons Why Military Spouses Don’t Ask for Help

Why do you think that military spouses are reluctant to ask for help or seek counseling?

Here are 10 reasons why military spouses might not ask for help (even when they need it):

  1. We don’t want to bother anyone. As military spouses, we don’t want to have to bother anyone with our troubles. We might assume that we don’t have a right to do so. We might think that if we do the person we ask for help will think less of us.
  2. We think we got this. Military spouses try to stay strong. We think we can do everything ourselves. We don’t want to have to admit that we need extra help.
  3. We don’t know where to go for help. We might want help but we are unsure of where to go to get the help that we need. We are not sure who to call or who to contact in order to find that help.
  4. We think we have to pay for help. If you are not sure about what your options are, some military spouses might assume that you have to pay to go see a counselor. If you have Tricare, they will pay for some if not all of your counseling. You should check and see what is available and what you have access to. There are other free programs out there as well.
  5. We think our need is temporary so we just want to get through it. When military spouses are going through a difficult situation, it can be easy to think that the situation will go away soon. That they really don’t need to ask for help. The problem with this is that sometimes the issues don’t just go away and we really should be looking for someone to help us through them.
  6. We worry about others finding out. Military spouses worry that others will find out if they had to get help for what they are going through. They might fear that others will make fun of them or look down on them.
  7. We don’t want to come across as weak. We don’t want to come across as weak to our spouses as well as others in our community. We worry that if they find out we needed help, they would no longer think we are strong. We have this idea in our heads about how military spouses are supposed to act and we feel like seeking help would mean we have failed to live up to that.
  8. We don’t think we have time. Life is busy and scheduling a counseling appointment might not be easy to do. Some military spouses might want to go and get help but feel like they just have too much going on to add that appointment to their schedules.
  9. We are not sure it will help. Deep down we might be worried that asking for help won’t even do what we need it to do. That we will be wasting our time. 
  10. We think we will look bad to our spouse’s command. This is a fear that some military spouses might have. That they will look bad to their spouse’s command. That they will be known as that wife or that husband and that seeking help will cause harm to their service member’s career.

The truth is, there are a lot of ways for military spouses to find the help that they need. Programs like FOCUS which stands for Families OverComing Under Stress can help spouses find the help that they need to get through their difficult situations. FOCUS offers resiliency training to help children and adults process and grow from their stressful situations.

There are also options to meet with a chaplin, Military & Family Life Counseling (MFLC) Program or be seen by a professional counselor through Tricare or MilitaryOneSource.

During my last deployment, I ended up seeing a counselor because I couldn’t handle what I was having to deal with. Taking the steps to make this happen was difficult but I was able to get the help I needed and learn more about how to handle my feelings as I got through the deployment. I was very glad that I did seek the help even though it was hard to do so.

If you feel like you need extra help, don’t be afraid to ask for what you need. You will be glad that you did as you will be able to learn and grow as well as figuring out the tools you need to get through military life challenges.

Now it’s your turn: Why do you think that military spouses are reluctant to ask for help or seek counseling?

How to File an Appeal or Grievance with Tricare

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There are options for your family to reach out to Tricare if you have any issues with medical care received or are hit with an unexpected bill.

How to File an Appeal or Grievance with Tricare

Tricare has 4 types of appeals.

Health emergencies can happen at any moment. Typically, things go way too fast for our thought process and there isn’t the luxury to think things through like, “wait, will this decision eventually bite me back with a huge medical bill?” We go to the doctor without question, so ourselves or our loved ones can get treated.

What do we do when that happens?

Your family can file an appeal with Tricare.

How to file an appeal

In Tricare’s words, an appeal is “the action you take if you don’t agree with a decision made about your benefit.” Because it’s particular to decisions, there are separate appeals you can file. Tricare offers 4 different types of appeals: factual, medical necessity, pharmacy and Medicare-Tricare.

Factual appeal: when payment gets denied or stopped for services or supplies that have either been received or authorized already.

Medical necessity appeal: when Tricare denies previous authorization because they assessed that it isn’t medically necessary anymore. The website outlines:

to be medically necessary means it is appropriate, reasonable, and adequate for your condition.

Pharmacy appeal: when your pharmacy prescriptions gets denied when you deem it necessary

Medicare-Tricare appeal: when you qualify for both, you may need to file with Medicare separately with their terms.

With the exception of the Medicare-Tricare appeal, the others require a written letter within 90 days of the decision. Along with that letter, add all your supporting documents that you have and the decision letter itself. For a pharmacy claim, you need to be specific on why you disagree.

The letter needs to be mailed to your contractor’s address (depending on where you are located). Tricare outlines the addresses in this link. You can also take your case a step further by requesting a formal review, reconsideration of decision or an independent hearing, depending on your type of appeal. That’s why I also encourage you to read more about each separate claim on Tricare’s website. That way you can assess your situation better: factual, medical necessity, pharmacy, and Medicare-TRICARE.

There are ways to continue the process when a decision doesn’t come back in your favor.

How to file a grievance

Also, we expect our medical practitioners to be diligent and appropriate when they work. When you are disappointed with your care, there are steps you can take to file a grievance with Tricare, so that your voice is heard.

Similarly to filing an appeal, you must write down your complaint and send it to your Tricare contractor’s address. The letter should outline the description of the event in question (date, time, name of practitioner, location, etc.). I suggest you be as detailed as possible and don’t forget to include any supporting documents.

Also, if you have any issues with dental care with your Tricare Dental plan, that is included too. It’s not limited to situations within medical care facilities.

In addition to your letter, share your sponsor’s Social Security number and all your information as well (name, address, phone number, date of birth, and sign it!). Tricare has a special website for grievances and I urge you to read it here.

If you’re filing an appeal or grievance for a dependent, include all the dependent’s information including your own. It’s good to share more during an appeal or grievance process that way they have the most comprehensive information. The whole family is covered, whether it’s the service member sponsor, spouse and children.

Have you filed an appeal or grievance with Tricare? What was your experience with the process?