It seems like every time a health problem occurs in our family, I end up having to fight – quite hard – to get things taken care of properly. There’s a solid protocol in place when you’re on Tricare, and I understand it’s important to follow procedure. However, it seems ridiculous that service members and their families have to work so hard to get proper medical care. I have a story and some tips on how to help you get the care YOU deserve.
This last year, my six year old had reoccurring medical issues. We are on Tricare Prime, so we followed procedure and made an appointment with the base doctor. It ended up that we saw a Resident (and couldn’t get into his PCM for over 2 weeks). Here’s where our fight – and my lesson in being my child’s advocate – began.
After 3 separate visits to the pediatric clinic, we were finally given a referral to a different specialist. The specialist on base took the referral so we weren’t allowed to see an off-base doc. When we saw the specialist, we were told to wait another month and “see what happened.” At this point, my son’s medical issues were already impeding his learning at school and his social interactions. I couldn’t wait. I hit Google to figure out what I was allowed to do through Tricare to get a 2nd opinion for my son.
This was not an easy journey. Looking back now, it was worth it to fight and advocate for my son because the moment we walked into a civilian specialist, she took one look at him, told us what the solution was, and scheduled him for surgery. Problem was, the 2nd opinion referral didn’t cover surgery – it only covered the office visit for the 2nd opinion. So, back to the base doc we went. It’s a convoluted story to get my point across, but it’s what we lived through the last 4 months of 2014. I learned two important lessons from the games we had to play with Tricare to get everything covered and make sure my son had the best care possible.
1. Know your rights
I’m not kidding when I say it felt like an all-out battle every time we hit another step in the process of getting him care. You HAVE to be your own advocate (or your kids’ or spouse’s). Just like any government machine – if you’re not the squeaky wheel, you won’t get the grease. I had to do research to learn what was allowed by Tricare and what we were able to push for in order to get him the best care possible.
When medical issues arise, you have to become an expert in the area because it’s not going to be easy and you’re rarely going to have someone holding your hand along the way to help. I’ve spent too many hours on the phone to count making sure that we got the care we deserved and that it would be covered under our Tricare insurance. If you’re facing a battle with a machine like Tricare, you must know your rights!!!
2. Don’t give up
Back to my “squeaky wheel” scenario, you might find that you have to push back and continue to fight even when it seems like you’re not making progress or getting the care you desire. I became a weekly visitor to our base pediatric office. I’m sure my son’s doctor was sick of seeing messages from me (and I know he avoided eye contact when we crossed paths at the base gym). But, for my son, I couldn’t give up.
I was convinced that he needed something other than what the base clinic was offering, and I pushed for it and did not let up until he got the care he needed. I felt vindicated when I walked into that civilian doctor’s office and was told I was right! It’s important to remember, though, that if you’re dealing with a medical issue you can’t always trust the first opinion you receive. Follow your instincts. Be persistent when necessary. Make sure that you and your family get the care that you deserve.
For more content like this, check out Everyone is an Advocate.
Photo Credit: Flickr user UW Health