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Civilian “pay patients” soon will not have to front the cost of their medical coverage at military medical clinics throughout Europe.

Starting June 1, the Europe Regional Medical Command will send the medical bills directly to insurance companies instead of patients themselves, taking away a lot of the paperwork and initial charges to the patients.

“It’s the right thing to do,” said Brig. Gen. Elder Granger, who heads the medical command. Granger said the move will bring the command’s three hospitals in Germany, and Army clinics around Europe, more in line with commercial operations in the United States.

It represents the second major change in billing procedures in the past seven months.

Late last year, pay patients in Europe who were used to paying a flat fee per visit for all services and medication needed, instead started receiving itemized bills that caused more than a few cases of sticker shock.

Granger said he received a number of complaints, and he acknowledges a general consensus that medical care is now more expensive for many pay patients.

But he said Congress — faced with pouring in millions of dollars into the military’s medical system each year — decided that civilians needed to pay an increased share for their health care. So the military worked with industry professionals in the States to devise a set of fees.

“There’s a whole slew of organizations that we consult with,” he said.

While the care is now more expensive for many, he contends it’s not more than patients are paying in the States for similar services.

“You don’t want to be way out in left field when it comes to rates,” he said, adding that most fees are similar to what people could expect to pay on the economy in the countries in which they’re living.

Granger said that while the command can’t do anything about the fees it charges, it can help patients who sometimes have to wait weeks to get reimbursed for their initial payouts. And the command is looking to contract with a company to take care of the processing of the paperwork, which is sometimes daunting.

In fact, Granger said he’s heard of several cases where people decided just to eat the costs and not submit the paperwork to their insurance companies at all.

“They’re not experts,” he said of pay patients and paperwork. “We do it every day. We know how to do it.”

Some clinics in Europe, mainly operated by the Air Force and Navy, already are billing insurance companies directly. Sometimes it requires the patient to pay a small fee during the visit and get the rest billed to the insurer.

But the move by the Army’s medical command will affect more people. It runs the three largest military hospitals in Europe and expects to schedule about 127,000 visits during the current fiscal year.

That’s a lot of paperwork to deal with. But Granger said advances in technology should help eliminate a lot of the actual paper and speed the process up. He expects that a majority of billing will be done electronically “like it’s done every day in the private sector.”

That would allow the military system to get the bills paid in about the same amount of time — without having patients write checks for large amounts during their appointments.

Granger said he has heard complaints the command doesn’t care about the pay patient population any more. He said that’s not true.

“We truly understand the role that the civilian population plays here in Europe,” he said.

He said the command can’t do anything to change the fees it’s charging, but he hopes the new billing system “will help to make this more palatable.”

Visiting the doctor

A visit for a new patient will generally cost more than a visit for an established patient because more time is required for the provider to obtain the patient’s family history and medical history. A visit is considered "new" if the patient has not been seen at a medical treatment facility within the past three years. All office visits are billed based on the complexity of the patient’s condition or the amount of time required for the provider to complete the visit. The costs listed below are billed regardless of the medical specialty of the health-care providers, such as optometrist, obstetrician, cardiologist, pediatrician, etc.



¶ Office visit for established patient 5-minute visit 25-minute visit

$19 73

¶ Office visit for new patient 10-minute visit 30-minute visit 60-minute visit

32 84 155

¶ Emergency department visit


The ten most commonly performed medical procedures for pay patients:

¶ Psychiatry diagnosis/evaluationThis is face-to-face time spent interviewing and observing the patient.


¶ Routine eye examRoutine exams performed by an ophthalmologist or optometrist.


¶ Physical performance testMeasurement of functional capacity with a written report. Test lasts approximately 15 minutes.


¶ Individual psychotherapy (45-50 min)Face-to-face consultation with goal of modifying behavior. Analyst is seeking insight into patient’s history and illness.


¶ Complete electrocardiogramRoutine EKG. Test includes interpretation and report.


¶ Drawing blood (Lab work)


¶ Therapeutic exercisesTherapist has direct contact with patient, and exercises cover one or more areas, with each lasting 15 minutes.


¶ Therapeutic or diagnostic injectionInjections designed to provide therapeutic relief or diagnose a particular ailment.


¶ PAP smear


¶ Hepatitis B vaccineVaccine consists of three-shot series. Fee is charged for each shot.


Source: Europe Regional Medical Command

author picture
Kent has filled numerous roles at Stars and Stripes including: copy editor, news editor, desk editor, reporter/photographer, web editor and overseas sports editor. Based at Aviano Air Base, Italy, he’s been TDY to countries such as Afghanistan Iraq, Kosovo and Bosnia. Born in California, he’s a 1988 graduate of Humboldt State University and has been a journalist for almost 38 years.
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