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Congress should direct the Department of Defense to end "neglect" of medical beneficiaries who use Tricare Standard, the military fee-for-service insurance plan, rather than Tricare Prime, the managed care program more favored by officials, service associations have urged.

The only "handbook" available to Tricare Standard users to check on whether civilian physicians will accept them as patients is "the Yellow Pages," said Sue Schwartz of The Military Coalition, an umbrella organization for more than 30 service associations and veterans groups.

Schwartz and other group representatives testified before a House armed services subcommittee last week [March 27] and gave lawmakers a list of recommendations to improve the Standard program and broaden health care opportunities for beneficiaries not enrolled in Tricare Prime.

"Simply stated, Standard beneficiaries are neglected by DOD," said Schwartz. "No effort is made to reach out to these beneficiaries, to educate them about the extent of the Standard benefit or support them in locating a provider. And The Coalition sees no [planned] solution on the horizon."

Indeed, support for Standard users actually could weaken in the months ahead if Congress takes no action, suggested Dr. Marjorie Kanof, military healthcare auditor for the General Accounting Office. Kanof confirmed that the next generation of Tricare support contracts, to take effect later this year, "will no longer require" contractors to provide all beneficiaries who ask with information on providers who participate in Tricare nor will they have to assist them in accessing care.

Schwartz said Tricare officials should be told: develop and fund a program to educate beneficiaries about Standard benefits; assist Standard users in locating healthcare providers; explain what steps DOD will take if patients cannot find a provider who accepts Standard; develop and fund a program to educate civilians providers about Standard.

Tricare also should build a data base of physicians who will or will not accept Standard patients and give beneficiaries access to it, Schwartz said.

Almost two million beneficiaries use Standard. Many do so for the freedom to choose their own doctors. Others live too far from a base or a Tricare network to enroll in Prime, or they have other health insurance and only use Standard as a backup.

Patient costs are higher under Standard. Most face a $300 annual deductible. Then they pay a portion of Tricare's maximum allowable charge for any procedure. The cost share is 20 percent for active duty dependents, 25 percent for retirees and their dependents. An additional 15 percent charge, above the so-called TMAC rate, is also possible if doctors or hospitals refuse to accept TMAC rates.

By contrast, Prime patients pay a $230 annual enrollment fee for individual coverage or $460 for family coverage. Retirees and their families face modest co-payments too for office visits or lab tests.

Because DOD is inattentive to Standard patients, said retired Army Col. David B. Vann, many retirees under age 65 and their families have seen "no measurable improvement in their health care" for years. Though TRICARE Prime has improved, Standard is "the major source of beneficiary dissatisfaction." Many doctors who accepted fee-for-service patients when the program was called CHAMPUS don't any more, Vann said, because physician reimbursements are too low and claims processing is too slow.

Vann represented the Military Retirees Grass Roots Group which wrote and distributed to members of Congress a White Paper last year on the failings of the Standard plan.

Vann joined with Deirdre Parke Holleman, of the National Military/Veterans Alliance, in urging Congress to end a requirement that Standard users residing within 40-miles of a base hospital get a "nonavailability statement" (NAS) from hospital authorities.

Otherwise, Standard won't cover the procedure. The NAS requirement is to ensure that base hospitals always have enough patients to operate efficiently, keep medical skills sharp and properly train its staff.

But given the higher out-of-pocket costs that Standard patients face, they deserve real freedom to choose their physicians as they would have under any other fee-for-service plan, Holleman said. She echoed Schwartz's call too for DOD to better educate Standard users and help them find providers. Congress also needs to raise Medicare reimbursements for doctors. Those fees also are used by Tricare but current reimbursements are too low to encourage physicians to accept Standard patients, she said.

"In much of the country," Holleman said, "Tricare Standard has become a phantom benefit."

Robert Washington Sr. also testified for The Coalition. Capt. Marshall Hanson, a retired Navy reservist, said if DOD wants to turn reservists into "instant warriors," mobilizing them within hours, they should accept pre- and post-mobilization responsibility for their medical care.

Comments and suggestions are welcomed. Write to: Military Update, P.O. Box 231111, Centreville, VA 20120-1111 or send e-mail to: milupdate@aol.com


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