Military Cancer Care

Hi I have tricare prime they will pay for half,my daughter needed a eye exam and they paid half.My husband retired 2 years ago he was in the navy for 20.....godbless roxy

SoCalLisa,

I just went to see my pcp, and I had to see her partner, because she had  the 'bends' after scuba diving on vacation, and flying back home the next day...  I found out she is NO longer going to practice medicine.  She was flaky anyway.  I hope her partner is going to work out.  He is ok, but I prefer FEMALE pcp drs... 

At least, he listened to me, and I told him that I need a trans vaginal u/s, because I have fibroid tumors, and Tamoxifen can cause uterine cancer, and I asked him to write up an order for me to see an ophtalmologist, b/c of the cataract issue.  The whole 'eye exam' every 2 years confuses me, because I always have to pay for my glasses anyway. 

Thanks!  I'll see what happens next.  If I don't hear anything tomorrow, I'll call my case manager on Wed.   BTW, does anyone have a case manager thru Health Net?  I do, but she is no help whatsoever.  After my bi-lateral mast., I got a call from Tricare, telling me that I was eligible for a case manager to help me get thru all the red tape.  My first case manager was GREAT!  Monica used to be a nurse for a ps who specialized in breast reconstruction!  She was a God send!  She got me thru most of my tx, up through chemo.  She even called my onc to explain that since he agreed to see me, he had to accept whatever TRICARE paid.  Shortly after, she quit. 

This case manager I have now is no help... She keeps sending me letters every month, saying that I 'STILL don't know how to self direct my medical care...  WTH?  No, I don't know HOW many visits each referral covers, or what codes to put on the requests...  I don't work at a drs. office, so HOW am I supposed to know all this?

Thanks everyone...maybe you can shed some light on this process, so I am not such an idiot.  We live too far away from a MTF, so I have to see civilians.

Harley

I am retired military with Tricare Prime. I am being treated at Brook Army Medical Center in San Antonio,TX.  (I also work there!) I have received excellent treatment thus far - surgery (bi-lat with snb and expanders) scheduled for July 2.  As I am single and live alone, I requested to be sent closer to my family for surgery...I was denied because I had already had 1 surgery (lumpectomy, no nodes) here with no problems. ??? I am confused as to how this is a valid reason for denial, but my care co-ordinator told me that they very rarely approve letting you move from one Tricare district to another if the managing company changes. I would have changed from Foundation to Humana, or vice versa.  Oh well, I'll just have my mom come down to help me out.

Other than having my first bs deployed right before my inital surgery date, I have had no real problems.

Maybe you all know this but I did not:

Breast cancer is the third most common cancer among TRICARE beneficiaries. TRICARE has changed its policy adding coverage for Magnetic Resonance Imaging (MRI) screening for women at high risk of developing breast cancer. Anyone who meets the criteria for a breast MRI will be covered by TRICARE retroactive to Mar 1, 2007. If any qualified beneficiaries received this care on or after that date, and it was denied, they can resubmit their claim for reimbursement. The American Cancer Society has guidelines for defining high risk which doctors can use to determine who qualifies for the coverage.

For more details check http://www.triwest.com/provider/articles/01_15_08_1.aspx

Minz 

Buttercake2 ~ I am so sorry you are going thru all this, especially the divorce during this.  I believe that you will still get coverage until your divorce is final and at that you might be covered under COBRA.  Or maybe state assistance? Are you a gov't employee? If you are a gov't employee, they do have really good benefits  and you may qualify for a 'change of life' circumstance which will let you enroll now without discontinuing coverage.  I am not an insurance specialist, so maybe someone else can help you better.  I am a gov't employee and I service Sill.

 I am also 31, IIIc, but ER/PR-, Her2+

To Buttercake2,

You really need to get a lawyer.  What's the rush?  You'd think your husband would let you get through treatment first.  For Goodness sake don't sign anything until you have a lawyer look at it.  Hold your ground girl.