Military Special Needs Network

Proudly Supporting all Military Families with a Special Needs Dependent

Adequate? At Best!

494814947

SOS: Our healthcare benefit needs serious help.

You have to hand it to Tricare. They tell you right up front what you’re entitled to as a military family member. The word “adequate” is frequently used to describe our healthcare benefit: “adequate” access to services and “adequate” care to “adequately” meet the family’s needs, just to give a few examples. “Adequate” can be defined as “barely suitable or sufficient” – certainly nothing like the healthcare benefit I imagined.

I haven’t always been so passionate about the healthcare of my family. I haven’t always been concerned about laboratory test coverage, prescription co-pays or compounding, or access to mental healthcare providers. Seven years ago that all changed when we adopted our sons. Our sons, we would discover, would have chronic medical and mental health needs which would need constant monitoring, working with therapists, and necessitating pharmacological assistance. It was then I learned exactly what Tricare had in mind with its repeated mention of adequacy.

From incredibly long wait times to see Primary Care Managers to 6, 8 and even 12 month wait lists to see pediatric specialists, to hours long waits at MTF pharmacies only to be told that the drug you need refilled is currently out of stock to the constant reworking and confounding ABA guidelines, to incredibly limited access to admittedly inadequate mental healthcare professionals – these have been our experiences as a Cat 5 EFM family. On either coast. And, as a family advocate with Military Special Needs Network, I have assisted countless families across the country with similar hardships caused by the Tricare “adequacy” plan, leading me to believe wholeheartedly that this is a systemic problem. A problem, it seems, with a very poor prognosis.

We’re hearing about forced recalls for Tricare Prime enrollees. The thought is that since the War on Terror is over, medical staff will be returning from the frontlines – never mind the mindboggling question of why a developmental pediatrician would be sent to Afghanistan in the first place. That major influx of medical staff will enable our Military Treatment Facilities to now have appointments for the thousands of Prime families who had been farmed out to civilians due to lack of available appointments (see the above mention of 6, 8 and even 12 month waits). Or so they say. Retirees and family members will now be forced to leave their trusted civilian providers in favor of strangers and group care.

We know that against advice from the American Congress of Obstetricians and Gynecologists, Tricare and the DoD brain trust have decided to no longer cover prenatal screening for Cystic Fibrosis.

To better serve their beneficiaries, Tricare has decided to stop their coverage of compounded medicines. Compounded formulas are especially needed for those with allergies to dyes often found in premade meds, for pregnant women, and for children – many with mental healthcare needs.

Civilian providers working at MTFs in certain locations are being pink slipped. For those who have visited their MTFs or tried to get an appointment for a sick child only to be told that they can either see their PCM in 9 days or visit the local MTF Emergency Room, they know that pink slipping any MTF employee is the exact opposite of what is needed.

Now I appreciate the truth in advertising Tricare is displaying, what with all their use of the word “adequate” to describe the truly less than stellar product they have created to reward American servicemembers and their families. I really do. But when was the last time you found yourself saying, “I’d love to take a really adequate vacation!” or “I’d like nothing more than to find an adequate person to fall in love with and raise a family!”

Never. No one ever dreams of adequate. No parent looks for merely adequate healthcare for their children. And no servicemember puts him or herself into harms way, protecting America and her interests for their families to receive “barely suitable” medical care. Our Soldiers, Sailors, Airmen, Marines and Coast Guardsmen¬†fulfill their promise to this country everyday. It’s time for Congress to do the same and #KeepYourPromise.

Kelly_stars

9 comments on “Adequate? At Best!

  1. Linda
    July 1, 2014

    I agree completely with the article above but the reason that the developmental pediatrician is sent to battle zones is because first and foremost they are a soldier, sailor, airman or Marine with a very good chance that the military paid for their education and they get a nice bonus when they recommit.acheatah

  2. Yes, I do understand that part. It’s hard for me to reason out why a dev ped would be needed on the front lines, though. Especially when there are only 10 dev peds, Navy-wide. And the need is so great here at home. But I do certainly understand that, at the end of the day he/she is an American servicemember. Very good point.

    Thank you for reading and commenting, Linda!

    -Kelly

  3. Reblogged this on TRICARE Overseas Philippines and commented:
    We thought our members might enjoy reading how those in the states feel about their benefit and how the word “adequate” is used while “high-quality medical care” is used by DHA for our limited benefit when they know it is not even “adequate” due to a lack of quality checks on the providers.

    • Hello there!

      Wow – thanks for the reblog and stopping by to comment. I look forward to learning much from your blog. So nice to know our friends overseas are experiencing the beauty of “high-quality medical care” via DHA. I’d laugh out loud if it weren’t so very typical of our government. *sigh*

      -Kelly

  4. Michelle
    July 21, 2014

    My oldest is 27. Whe they were the age of 13, we started navigating Tricare and mental health. While I know that what I’m about to say is of little solace, what you receive in care for your children is almost 100% better than what I had to fight for back in the dark years. The head of pediatrics actually told me that Aspergers’/Autism was something that he knew little about – it was not quantifiable by any lab test or X-ray. And, sad to say, Tricare offered us better mental health benefits, even with the constraints than most civilian parents who had children with similar diagnoses. Even as an adoptive or foster-care parent, there were doors open for you that were not open to us – programs that possibly would have been helpful , but were only open to children who had been “placed”.

    • Without a doubt you had it worse than I do. Absolutely.

      But, really, “there were doors open to [me]” as a foster parent? For you even to suggest that indicates you have precisely zero knowledge of the foster care system. Did you know, for example, to get your kids seen by specialists or to get them on any medicines beyond antibiotics you need a judge’s approval? You see to have a kid on anti-psychotics makes them infinitely LESS adoptable.

      Let me tell you about the open doors for children born addicted to meth: they get precisely Jack Shit. That’s right. Nothing. You want any sort of therapy, you need a diagnosis of LD, GDD, ASD or some other damn “D.”

      Let me share with you the glory that is Medi-Cal: cattle-call dentists, waiting room with literal piles of shitty diapers, a slew of providers who will not take the insurance due to the craptastic reimbursement policies, waiting lists, doctors who take Medi-Cal are typically a special kind of doctor – those who have lost their give a crap decades ago.

      Let me tell you about the mountains and mountains of paperwork, hoops to jump through, and home visits.

      And, that’s not even the work that has gone into our children to repair the damage that the foster parents had done.

      So, please, let’s not do this. I’m not going to play the Hardship Olympics. I’ll just let you win and go back to soaking up the glory that is my current state of adequate healthcare.

      • Michelle
        July 21, 2014

        I am well aware of what kind of hoops you have to jump through, having worked with those in the foster care system. And I’ve had my kids on anti-psychotics as well as numerous hospitalizations, residential care, etc., etc., etc. There were some great programs that were not open to my children because they were my own flesh and blood. I’m not trying to one-up. But, imperfect as it is, it is much better than it used to be. that’s all, that’s my point. Why is it every time I share these sorts of things to illustrate how far we have come, I am treated like a villain? I’ve walked your road, there’s no need to be so defensive.

        Good thoughts for you, it is a rough, difficult road you have chosen.

  5. Devon
    August 19, 2014

    I think this is one of the most significant info for me.
    And i am glad reading your article. But wanna remark on some general things, The website style is great, the
    articles is really greatt : D. Good job, cheers

  6. Maddison
    August 21, 2014

    Woah! I’m really enjoying the template/theme of this website.
    It’s simple, yet effective. A lot of times it’s difficult to get that
    “perfect balance” between user friendliness and visual
    appeal. I must say that you’ve done a amzing jobb with this.
    Additionally, the blog loads super quick for me on Internet explorer.
    Superb Blog!

Comments, discussion and insight always welcome!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Oh Mah Deehness!

Allergy Friendly Family Life

Isn't That Marvelous?

It's serious. It's sarcastic. It's sweet. It's sincere.

TRICARE Overseas Philippines

A site to discuss and learn about TRICARE Philippines Policies and Issues that are often times implemented in secret by the Defense Health Agency (DHA). Policies that result in payments at about 7.7% and 3.8% of what they should be or $328 per under 65 person instead of the expected $4,261 & $328 per over 65 person instead of the expected $8,650.

Seasoned with Love

words and recipes from my kitchen to yours

GENTE COSMO

LIFESTYLE - by Esther Herrero

hansstellingsma

living the saga called life....

Being The Bergerts

Vet tech student. Student Naval Flight Officer. Professional napping dog.

ArillaBlog

finding contentment in the unexpected

thejuliemeister

Musings from an unsuspecting navy wife

The Ugly Volvo

Attempts at Adulthood

anseo

inken thought

Special Needs Resource Fair

Bringing Community Resources Together to Support Families with Special Needs

Ketchup With a Side of Autism

This WordPress.com site is about the ups and downs of life and autism.

catonatrampoline

Autism, Parenthood and life...

OMazing Kids

a fun site for inclusive wellness activities for kids of all abilities

The Journey of a Thousand Sticks

Homeschooling, gardening, parenting, special needs, Buddhism, living, drinking, eating and loving.

%d bloggers like this: