When you found out that you would be seeing your new Primary Care Manager (PCM) off-base, you were shocked, then intrigued. TRICARE Prime patients typically only see providers at military hospitals or clinics. However, when a Military Treatment Facility (MTF) is filled to capacity, it’s a necessity to send you elsewhere for care. After a few months, or perhaps even a full year, you’ve fallen in love with your civilian provider and are enjoying the luxuries of off-post care. Out of the blue, the military clinic calls you up to say, “We have a spot for you.” Space has been freed up and TRICARE wants to switch your care to a provider on base.
Don’t panic. You have options.
How to Keep Your Provider
Your first thoughts might be, “absolutely not,” and we get that. You and your doctor have built a great rapport in the time you’ve been working together. She knows your bloodwork, all of your medical history, and has the patience of a saint with your whiney kids. They do not request your sponsor’s social at every visit. They actually HAVE appointments (even emergency ones) when you call. The thought of having to give this all up and build a relationship with another new provider is too much to bear. There may be a provision in place just for you.
Here what you can do:
Call, or speak to, your PCM. They need to file a request to Tricare for continuity of care so that you can continue to see them. Tricare should be able to honor this.
Here’s what you should not do:
Try switching to Tricare Standard (unless it is currently Open Enrollment Season). According to the rules, you cannot switch between Prime and Standard unless it is Open Enrollment Season, which runs from the Monday of the second full week in November to the Monday of the second full week in December. The only other way you could switch is if you have experienced a Qualifying Life Event (QLE) in the last 90 days. For example, pregnancy is not a QLE, but the birth of a child is. Once Open Enrollment starts, switching from Prime to Standard would prevent this from happening to you again.
Switch to the Military Treatment Facility
Here’s another option: switch to the military hospital or clinic that wants you back.
More than likely, they just shed a large number of patients due to PCS season and have more time in the schedule for you. MTFs are staffed with caring individuals who are completely familiar with the norms of military families. It’s generally less “touchy-feely” care, as they are seeing tons of people every day, but you will still get all of the appropriate intervention. And since you’ll already be there for appointments, it makes it more convenient to pick up prescriptions at the zero-copayment pharmacy on location (if your clinic has crazy wait times, look into Express Scripts!). Chat with your friends to find out who the bee’s knees providers are at your hospital and ask for them!
If you get the call, don’t freak, and don’t feel like the system is trying to squash you. Just stay cool, remember that you have options, and voice your needs.
Call TRICARE for more information.
WANT TO READ MORE?
Check out this article on Medical Malpratice in the Military: What Are Your Rights?
Photo Credits: Tricare, Pixabay, Hush Naidoo