Secondary medical care a costly dilemma
October 26, 2003
When Yokosuka Naval Hospital staff encountered a catastrophic illness they couldn’t treat four years ago, they sent the patient to specialists off-base.
The patient, the mother of a petty officer 2nd class from Atsugi Naval Air Facility, wasn’t eligible for the military medical benefit program Tricare, Navy officials said. And the family didn’t have insurance.
So payment for related cardiac treatment had to come from the E-5’s pocket — $50,000 in medical bills the servicemember is still paying off, officials said.
The case is not unusual.
A Yokosuka Naval Base servicemember is paying a $30,000 medical bill for treatment two years ago for her uninsured mother.
And last summer, the uninsured mother-in-law of an Air Force technical sergeant at Yokota Air Base needed treatment for a brain hemorrhage.
The E-6 appealed to the base community and his church for donations to help cover the $30,000 bill, hospital officials said.
While military spouses and children are covered by Tricare, other family members classified as “secondary dependents” — mostly parents and in-laws — are not.
They aren’t eligible for Japanese national insurance and outside of the United States, Medicare — the federal health care system for indigent and older Americans — isn’t available.
At Yokosuka, one-fifth of base residents are secondary dependents, according to a 1998 hospital survey.
Because they have military identification, secondary dependents can be seen in base clinics. But base facilities are not equipped for costly heart, gastrointestinal and other care some need.
“Because they are older, they get more expensive treatments,” said Aki Kumagaya, 374th Medical Support Squadron health benefits adviser at Yokota.
While Pacific military officials couldn’t provide figures, they say a few servicemembers with secondary dependents are left annually with thousands of dollars in medical bills.
The bills can top their annual salaries, officials said.
Additionally, Japanese hospitals prefer to keep patients longer than in the States. And in Japan and South Korea, medical expenses are paid up front or at the time of service.
Commander, Naval Forces Japan, which oversees Navy installations in mainland Japan and Okinawa, implemented a policy in January requiring servicemembers to have insurance for dependents not covered by Tricare, spokesman Cmdr. John Wallach said.
Servicemembers must show proof during hospital and clinic check-ins.
Failing to provide insurance could result in disciplinary action under Article 92 of the Uniform Code of Military Justice, Wallach said.
The policy is designed to protect servicemembers from staggering medical bills.
But even with the new policy, two Yokosuka sailors have been hit with expensive medical bills in the past six weeks, hospital officials say.
Similar problems are reported elsewhere in the Pacific.
“We definitely suggest it,” said Air Force Sgt. Kelly Kivett, Kadena Air Base health benefits adviser on Okinawa. “Most people don’t though because they can be seen on base. There’s really few things they have to go off-base for.”
Okinawa’s Naval Hospital refers about three secondary dependents a month off-base, according to Arlita McClintock, Tricare marketing representative.
Kivett said most don’t have insurance.
In South Korea, many dependents are insured.
“Most people do nowadays,” said Soyoung Harleston, 18th Medical Command Tricare enrollment supervisor in Seoul. “It’s their personal responsibility. But we haven’t had that many problems.”
South Korean hospitals require upfront payment, but American insurance companies pay after service.
That can mean thousands of dollars in out-of-pocket payments.
“It happens frequently enough that it’s an issue,” said Army Maj. Alan Ueoka, 121st General Hospital clinical support chief.
Those most at risk pay the most for insurance.
“They usually have a condition anyway that makes the insurance higher,” said Lt. Cmdr. Rebecca Malara, Yokosuka Naval Hospital case manager.
Since off-base hospitals expect immediate payment, failing to have insurance can strain relationships between bases and local medical centers, Malara said. Japanese hospitals may be reluctant to accept base medical facility referrals.
Tricare can work as an intermediary between hospitals and servicemembers working out bill payments, Ueoka said.
“But for the most part, that person is responsible for trying to negotiate a payment plan,” Ueoka said.
The problem may be devastating for military families, Yokosuka Naval Hospitale spokesman Bill Doughty says, adding failing to obtain insurance is a gamble servicemembers shouldn’t take.
“Some people think it can’t happen to me, but it can,” he said.