Research - Rehabilitation - Re-Employment

Sgt. Shaft 11/07/2005

Dear Sgt Shaft, I am an active duty member that serves as my command's Health Benefits Advocate (HBA) for Tricare. After Healthnet took over the North Region, I could do nothing but brag about how well they worked the TRICARE system and how good they were for TRICARE. I sang their name up and down and was telling every beneficiary I could about getting into TRICARE Prime so they wouldn't have to worry about paying thousands of dollars for another type of insurance when they had TRICARE Prime, especially our retirees. Now I have gotten a problem thrown at me and maybe you can assist.

I recently tried to enroll a newly retired Chief and his family in to TRICARE Prime, as we had Prime providers in our area. About a week or so after we sent in the families enrollment, they received a letter telling them they were not in a TRICARE Prime Service Area (PSA), and had to either sign for an access waiver, as the closest Provider is over 40 miles away or use TRICARE Standard to keep seeing the Network Provider they had been seeing for 3 years. When I started calling to find out what happened, I was told that Healthnet had grandfathered Humana's TRICARE PSAs for a one-year grace period and had changed the PSAs after the one year, and we were no longer in a Prime Service Area. We, the active duty and our family members, qualified for Tricare Prime Remote, but our retirees, their dependents and the dependents who are living in our area while their spouses were deployed were no longer eligible for Tricare Prime, unless they wanted to travel over an hour away.

In my investigations, I was told that since Fort Benjamin Harrison had been BRAC'd 10 years ago, they were eligible for a TRICARE PSA, but our base was not eligible. When I asked why we were taken off, I was told that since we did not have a high enough Active duty population, we didn't warrant keeping a TRICARE PSA. When I recited Healthnet's definition of PSA ("Formerly was called catchment area defined to be within a 40-mile radius of a military treatment facility. It now also includes areas containing a high concentration of TRICARE beneficiaries who are not within the catchment area of an MTF. Healthnet is required to offer TRICARE Prime in each Prime service area."), to the someone at the Regional office, I was told that PSAs were determined only by the ACTIVE DUTY population, not retirees.

Now how fair is it to take an environment that was TRICARE Prime, that has an installation employed by mostly civil service and contractors, who a good majority are retirees, in a state that has no Military Treatment Facility (other than a VA Medical Center in the middle of the state) and take away their Prime option, unless they want to spend most or all of their day in traveling to and from the doctor's office. I understand that retirees can use their Standard option at any accepting physician, or go Extra at a Network-provider, but they still have a $300/family deductible that must be met before they have their 20% co-payment, and they still have the $3000 catastrophic cap. They paid their country with 20+ years of their life to receive free healthcare, and now they are being told to pay up to $3300 every fiscal year to receive their "free" healthcare.

I saw your article concerning "TRICARE rules baffle beneficiary" and decided that maybe I would share my similar story with you and Mr. Lillie, who Mr. Emil K. placed on the letter you published. Hopefully you can assist me in making sense of why we that serve our country are being denied what we are told we could have for serving our country and now are essentially being punished because we are no longer active duty or living near a military hospital.

Thank you for your time, Angela
Via the internet

Dear Angela
I urge the Congress to review this Tricare bureaucratic debacle.

I am looking forward to being with Marine Corps General Michael Hagge today at a National Press Club luncheon as he kicks off Marine Corps Birthday week. Those interested in attending the Luncheon should call Pat Nelson at 202 662 7500

I ask my fellow members of the Marine Corps family to bow their head and quietly recite the following prayer:

"O Lord, we have long known that prayer should include confession. Therefore, on behalf of the Marines, I confess their sins: Lord, they’re just not in step with today’s society.
They are unreasonable in clinging to old-fashioned ideas like patriotism, duty, honor, and country.
They hold radical ideas believing that they are their brother’s keeper and responsible for the Marine on their flank.
They have been seen standing when colors pass, singing the National Anthem at ball games, and drinking toasts to fallen comrades.
Not only that, they have been observed standing tall; taking charge and wearing their hair unfashionably short.
They have taken John Kennedy’s words too seriously and are overly concerned with what they can do for their country instead of what their country can do for them.
They take the Pledge of Allegiance to heart and believe that their oath is to be honored.
Forgive them, Lord, for being stubborn men and women who hold fast to such old fashioned values.
After all, what more can you expect: They’re Marines!"

Send letters to Sgt. Shaft, c/o John Fales, P.O. Box 65900, Washington, D.C. 20035-5900; fax to 301-622-3330; call 202-257-5446 or email sgtshaft@bavf.org.

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