Where is the ‘Care’ in ‘Tricare?’


Update: Tricare changed their mind about this policy and instead is only putting it on retirees. Read more here.

Every military beneficiary, at one time or another, has had a complaint with Tricare. But, on the whole, Tricare is  far from the worst healthcare providers out there. If you only have common-place ailments, you could assume they have excellent coverage across the board.

I am here to tell you that is simply not the case.

Military families who have a child on the autism spectrum are currently rising to challenge Tricare on their new Tricare autism coverage policy for the way their children are able to access Applied Behavioral Analysis (ABA) therapy, set to go into effect July 25.

You can read all the details about the new policy, how it compares to the old one and why Tricare says they made the changes in Amy Bushatz’s Military.com story.

As a military spouse and parent of a child with autism I am one of those who are furious. The new policy limits of two year of therapy duration and standardized testing that is not fit for the purpose of measuring progress will directly affect my son.

He was diagnosed with moderate –severe autism at age two. He is now six and thriving thanks, in part, to the therapy known as “Applied Behavior Analysis” or “ABA” that Tricare is trying to limit in their new policy.

He has received over three years of ABA already, although never at prescribed levels. He is so high functioning that he might not qualify for additional therapy, according to the tests Tricare are requiring, and he is already over his “allotment” of time.

And even though he is currently thriving in a mainstream school setting without any form of dedicated aide and is social, happy and engaged with his world, he still has autism. He still struggles with reading social cues, he still struggles with attention and impulse control and he still has limited safety awareness.

He still benefits greatly from his ABA therapy and would continue to.

Although my son has made rapid progress in ABA after three years, other children do not. There is a saying in the autism community — “if you’ve met one child with autism, you’ve met one child with autism.” Basically, autism is a condition that varies enormously from child to child and an individualized approach is vital.

As families we should all be outraged. If Tricare can limit proven and prescribed medical treatments and therapies based on cost for one condition, what stops them from doing it for others? Why is Tricare limiting the very therapy that is so well-studied and researched to improve the outcome for children with autism? We wouldn’t dream of limiting medications or therapies for other chronic health conditions, so why is it OK to target one particular condition, that right now affects 1-in-50 school-aged children in the United States and 23,000 military kids?

We are all, as military families, fully aware of our current budget problems in the United States. We should be trying to cut costs. However, for a healthcare system that covers nicotine gum and Viagra, and a DoD that spends $34M on a base in Afghanistan that will never be used, surely there is other fat to be trimmed than the therapy of military children with autism? Wouldn’t the thousands of dollars of spending for the new testing requirements included in Tricare’s new ABA policy be better used for actual therapy that can improve a child’s independence?

Military families don’t have access to the benefits of autism reform legislation from state to state, because Tricare is a federal provision. And the waitlist for the Medicaid waiver programs that cover this therapy are so long most military families never get to the top of the list before they have to PCS.

Since it is PCS season right now thousands of families are bidding farewell to friends and schools and, in the case of those with children with autism, therapists and doctors. Tricare is imposing these changes during the most stressful time of the year.

As of today, Tricare, less than two weeks before the implementation of these new policies, has still not informed families or therapy providers of the details of these policy changes. Last week a post appeared on the Tricare website that contained some of the information, but not all, and not some of the vital points that are causing so much concern to families.

Military grassroots organizations have been ahead of the curve, and far ahead of Tricare, issuing clarifications to families so they can contact their Congressional representatives to challenge these arbitrary and capricious policy changes that only serve to restrict access to appropriate medical care for their children.

Tricare’s customer service representatives still have no answers for families about the policies. Many aren’t even aware of changes. Even Exceptional Family Member Program (EFMP) contacts at the bases are in the dark and unable to advise the families they serve. Tricare have even been challenged on their policies by Senators Kristen Gillibrand, D-N.Y., and Sen. Patty Murray, D-Wash., and so far we haven’t heard any response.

The whole situation is a debacle. We have a policy that was clearly designed without any input from providers or patients. Tricare is unable or unwilling to provide answers to reasonable questions and concerns from parents. Children are set to lose access to a therapy that has the potential to provide life-changing improvements for those affected, whose parents serve this great nation.

It’s time for DoD to really put the ‘care’ back in Tricare.

Sarah Stockwell, PhD is a former chemical researcher turned stay-at-home parent. She lives in Colorado Springs with her Air Force husband Jeff and their son Tom. Sarah volunteers with American Military Families Autism Support, has written for the Autism File Magazine and Age of Autism and in her 10 minutes of spare time a week enjoys glass art.

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39 Comments on "Where is the ‘Care’ in ‘Tricare?’"

  1. Agreed there are probably better ways to cut costs but look at it as you were receiving up to 36k a YEAR in ABA at a maximum cost of 3k to you, you foot roughly 8 percent of the bill, less if you count the fact that you don't have to pay monthly health insurance premiums. That's over a half a million dollars that ONE child is costing the tax payer for 16 years of treatment. If it is suggested to double or triple your cost share or have you start paying active duty premiums would you accept that over the changes?

    Under my private health insurance ABA isn't even covered until you can prove need (which it took one of my co workers almost 2 years to do). Once it is covered the co pay is 75 PER visit and that doesn't include his family health insurance premiums of 800 or so a month

  2. As a newcomer to the military life 2 years ago at the age of 39, please understand that Tricare gives more benefits and pays for more than any private individual insurance company every would. In no way am I saying that autistic children should not receive treatments BUT what I am saying is be grateful for the treatments that Tricare does pay for. Prior to marrying a soldier, when my son went to the ER – out of a $5,000 ER bill, the private insurance only paid about $500 of it. I also paid a monthly premium (for a family of 4 it was about $600 a month).

    Try to look at the positive and be thankful for what Tricare is paying. If you were on regular private insurance, would you expect your private insurance to pay out beyond the limitations on your policy with them. Just a thought. I do hope your child continues to receive the treatment needed. However, as the child's parent, that is your responsibility, not the governments.

    • We, too, had civilian insurance before hubby went active duty. One MAJOR draw was healthcare. In 1994, he was promised FREE healthcare for himself and his dependents for the rest of his life, if he served 20 years active duty. Well, because politicians have reneged, we have co-pays and deductables and a hell of a time getting the care I need(I have MS). Being AGR, he is not stationed at a base, post or fort. We don't have the benefits available on one. We don't have a tricare office to help us, and calling the 800 number is hit or miss, mostly miss. I can't find a doctor that knows enough about MS for me to feel comfortable seeing. The specialists that sub-specialize in MS do not participate in Tri-toget-Care. Just because our healthcare is supposed to be better than civilian, for more than a few of us, it isn't. Just because you are grateful for the healthcare, doesn't mean we should roll over and let the politicians off the hook for failing to fulfill promises to the very ones that keep us all safe. Our military members shouldn't have to worry about their loved ones not getting the healthcare benefits that were promised in exchange for possibly giving up their lives. It may or may not be "better than what's out there" but the government is not meeting it's promises. That would be like your boss having promised to pay you $XXX/month, then after you worked, say 'oh, well, I'm not going to pay you what I promised.' You wouldn't be very happy would you?

    • Jennifer, the problem is that Tricare is mandated to cover medical treatments. Who's to decide what is a worthy cost or a worthwhile medical condition and what is not? Just because one person does not see the worth in a medical treatment, that means it should not be covered for anyone? Why are we picking and choosing? For cost purposes, it is far more cost effective to treat autism early with therapy and have the chance of those kids going on to become productive members of society than to become nothing more than wards of the state. These children will become adults. We have a situation right now where people on private insurance are getting better services than those who serve in the military, because of the state laws that don't help our families. The 'be grateful' line only goes so far. Our spouses are military members and serve this country, with the risk of death or injury. They are not private citizens. Why should they not get the healthcare for this condition that is medically proven to help?

  3. Tricare is still an excellent provider. They’re going to have their bumps and roadblocks but instead of getting angry at Tricare, get angry at our government and get angry at the big names in Washington D.C treating the military like a mere chess piece. Be thankful for what you are provided and remember the families that don’t have the same privileges and access to care like we do.

    • The government actually voted to expand ABA coverage in a law passed last year. The new hoops and arbitrary and capricious changes that TRICARE is making, is suppose to be TRICARE's response to this law.

  4. mongolberry | July 16, 2013 at 7:51 pm |

    Before joining the army my husband worked in a Steel mill and was part of the Steelworkers Union, the medical insurance was paid for by the company and was much better than Tricare.

    • So was Teamsters.

      • And that's part of why most steel used is from other countries.

        • mongolberry | July 18, 2013 at 7:17 am |

          Not true, Toyota buys solely from AK Steel and many other companies use only American steel because of impurities in the metalurgical coke making process of foreign steel ^.^ Steel making is a thriving part of the economy.

  5. Access to care? Where? Sure you can probably find someone with MD after their name to take Tricare, but is that care quality? Often not. Not in my experience with the system. Try finding behavioral health care of any kind for any member of your family. Providers are few and far between. This ABA s#$/ sandwich they’re trying to feed us is just one of the many inadequacies of the system. It just so happens that this one isn’t even based on medical best practices and a lot of people have taken notice. Tricare? I think we could resurrect a lot of the old sayings like “Tritofindcare,” “Tridoesn’tcare,” or your version of choice.

  6. The fact is, those who have earned Tricare really don't know how good they have it. In the private sector family healthcare premiums are over $1000 per month for a lot less than Tricare. Maybe one way to gain a greater appreciation for what you have is to look at the Tricare Retired Premiums for member and spouse is near $1200 monthly. We are sorry anyone may need to pay for a part of their healthcare in specialized mental health medical treatment but be thankful for what you have and recognize 60% of Americans have no healthcare at all.

    • Wow, $1200 for Tricare retired premiums? I have two friends who are retired and they only pay around $60.

      • Brown, where did you get these numbers from? I just retired and it is $539.38 per year for myself, spouse and our son.

        Al D'Adda

  7. Steve, EMC, 14 years | July 16, 2013 at 8:40 pm |

    Guess my thoughts go back to we served or are serving our country. This includes the wife and the children. Those on active duty should receive every ounce of medical attention that is required ,and for the retire the same shall apply, they work or have worked for substantially less pay under more stress and hardships that any civilians job even knows about,( have worked 24year with the landlubbers I can attest ) Health of a veteran's family should not even be a question, period……

  8. Where I am at it isn't even called Tricare any more. It is now called United Health.

    • It is still TRICARE, united health has the contract just like Humana in the south region and federal health net in the north region.

    • United Healthcare is the new TRICARE contractor for the West Region. The TRICARE Managment Activity overseas the 3 CONUS and two overseas (Europe/PACFIC) contracts. The contractors are commonly referred to as TRICARE.

  9. If you think that TRICARE is so great join the military. You will find out what it's really like. If this policy change was about cancer and not autistic kids everyone would be saying how horrible TRICARE is. I guess if you don't have kids on the spectrum why should you care, right?

    • Having had cancer on private insurance I can PROMISE you that TRICARE is a ZILLION times better and cheaper than most corporate health care plans. We all care about kids on the autism spectrum, and the testing part of this is complete bunk, but come on, it's not out of the realm of reason to expect the parents to foot a larger portion of the bill if they want to maintain treatment past what health insurance would cover

      • This all depends on the insurance you had in the civilian world. Even at that it is still comparing apples to oranges. When hubby was driving semi's, our insurance was considered excellent. I had no trouble finding competent doctors on the plan. With Tricare, and being stationed remotely all the time, not so. The specialist I saw for my MS, knew less about it than I did, before I was diagnosed 10 years ago. He didn't treat a relapse properly and I ended up having to tell him how to treat me and threaten him with a lawsuit if he didn't(he said we only treat relapses if they are bad enough-I told him in no uncertain terms that it was bad enough.) I have had to buy my own walker and wheelchair. TC wouldn't pay for one I could actually use. If TC works for you–great. It doesn't work for a lot of remotely stationed families. It was PROMISED to our service members. To change the promised benefits after they have been earned by sacrifices is cruel. We could save a lot more money by cutting the benefits that our government officials get.

      • that is the thing. more and more health insurances are covering it. and I have chronic auto immune diseases that my private health insurance (before I was married) gave me better coverage and more freedom than tricare does now! I am grateful for what I have but they are treating ABA therapy for Autism differently than any other condition or life long disability.

  10. No one has ever "promised" any soldier, in the last 35 years "Medical treatment for life". However, it is available through the VA, if the Veteran chooses to use it. And if you "KNOW" he was promised it for the entire family, free, you had better pull out his contract and read it, because he apparently signed it without doing so. And I dont know where the first poster gets the idea that Military retired medical is free, thats a total load of BS. First off Tricare prime and Dental cost me nearly $225 per month. Tricare Delta Dental cost more and pays for less than most civilian plans. We have a $1200 annual cap, $1500 for braces. Whats yours? If you think Tricare Standard is free, you had better think again, there is an annual out of pocket deductible cap of $3000. The only difference between civilians (many of whom DO GET FREE HEALTHCARE) and us, is the fact that we are required to work and/or be on call 24/7 365. And that includes while on leave., oh and there is that little part about being shot at, away from family and all the rest. And before some dumbazz civilian speaks up and says "Yea, but you volunteered", well you volunteered for your job too, only difference is, if we didnt, there would be no one defending this Country. And before one of these civilians talks about how easy the job is, and how well it pays, then I ask "Where were you?" why werent you one of the 3% of Americans who took this easy comfy, high paying job? I get tired of reading and hearing the BS.

    • Yes, in 1994 recruiters were still promising healthcare for life-prepaid by your service for 20 years.

    • Outside of unions who gets free healthcare as civilians, certainly no one I know

      • You cannot compare benefits of civilian jobs with the military. The only civilian job that comes close are the police. Hubby had a good, safe(as in not risking his life-or ours, we were on a Jihad Jane's list) well paying job with good insurance. One benefit that was crucial to his going active duty(he was in the reserves) was that in exchange for low pay and LOOOONNNGGGG hours, he would earn healthcare for himself and his dependents for the rest of his life after 20 years of active duty. I get tired of hearing BS from people that don't understand the basic premise of fulfilling promises.

        • Retirees HAVE health care after 20 years for a ridiculously low yearly copay, how is that NOT fulfilling a promise? If you say it was supposed to be free, show me it in writing, because it wasn't in my grandfathers enlist papers, my fathers, mine or my husbands and we all know if it's not in writing it's not a legal promise

    • US Navy Ret | July 18, 2013 at 3:20 pm |

      Maybe but I was a navy recruiter who promised that in the early 90's.

      • The army recruiters were promising the same thing. That's what they, themselves, were promised.

  11. I joined the military in 1993 and married a fellow Army soldier in 1995. Three kids, several specialty doctors, surgeries, etc. later, I will never complain about tricare. Ever. So many of us just don't know how good we have it, even now. It's an insult and naive to say a civilian doctor who takes tricare is going to give substandard care. That's rubbish. There are good and bad doctors everywhere not just those who take tricare. My dad had excellent insurance, but they paid premiums each month on top of co pays. Some things were just not covered, period. We do not (as an active duty family). I have never been denied care or a referral, ever. We also have a son who is on the Autism Spectrum, high functioning. He doesn't qualify for any type of school aid, but he has had ABA for the past year. We have been very happy with his progress, but speaking with his therapist, she really provides no more then what we as his parents can give him or do with him. We had decided (we just PCSed) we were going to give a trial run to see if he really needs this service now that we have moved. With this said, I would be very upset if we did want to start ABA again and he was denied care because he doesn't qualify. Like the writer said, if you have met one child with autism, you have met one child with autism. Every child and adult I have met on the spectrum or previously diagnosed with Aspergers is vastly different. My child may not require extended care, but there are others who do and it would be a shame to take that way.

  12. Love the NIMBY (not in my backyard) sentiment of the article. The government needs to cut costs but not at my expense.

    The government needs to cut costs everywhere and some people just are not going to be happy about it. That's life.

    • There is a lot of waste in the government. Cut the benefits to welfare mamas(not everyone on welfare is a welfare mama) Cut the cushy retirements our representatives and senators get. Cut their medical benefits. Eliminate several federal agencies. Cutting benefits for service members that were PROMISED as pay in exchange for 20 or more of sacrifice is beyond weakening our forces. A government that doesn't fulfill it's promises is going to die. It will not be able to maintain it's forces for protection.

  13. Parents of autistic children are not alone. For several years my wife has taken thyroid medicine compounded specifically for her condition. We just got a letter saying Tricare would not cover it because it was not standard medical practice. They included a list of thyroid medications she could take. She went through those years ago and they did not work.

  14. Marshell Crider | July 17, 2013 at 10:40 pm |

    Tricare needs to cover Chiropractic care

  15. When I joined the Navy in !(^$ I fell for the "OLD DONT WORRY THE NAAVY TAKES CARE OF ITS OWN" If you stay in you will have the best Medical Dental Eye care anything that is wrong we will take care of at no cost to you , its all part of your benefits on retirement. B/S pharmacy benefits I cant use my local Walgreens (its a 24/7) and the rest in my town close at sundown. The mail order pharmacy you need to get the script in 30 days in advance in order to have the slightest chance of receiving your meds in time. Most Doctors wont wright scripts in advance that far out. Can we say screwed boys and girls.

    • Bert Meyer | July 18, 2013 at 3:16 pm |

      Walgreens decided to remove themselves it was part of the Tricare program until 2 years ago Tricare had nothing to do with this it was Walgreens that opted out.

    • Actually, we use the mail order system and it works very well. Doctors fax. Get a short bridging precript. You can reorder and set dates and also get them to get new prescripts …. All handled on line. Opioids and liquids are generally not shipped. Once we shifted under TFL, even the TRICARE copayment plummeted.

  16. My son has been diagnosed with a Learning Disability through the school system. We have come to find out that the following is NOT covered (taken directly from the Tricare website):
    Learning Disorders
    TRICARE does not cover diagnostic, evaluation, treatment, services or supplies (including special education services) for learning disorders, such as dyslexia.
    As we know, reading is something that takes place EVERY DAY. If the children that suffer from a Learning Disability are not able to read at grade level, we are setting them up for failure. We have looked into having our son tested and the cost ranges anywhere from $500 up to $1,800 with NO costs covered by Tricare. Upon further investigation, we found that gastric bypass is covered. Please know that I understand that weight is an issue for MANY MANY MANY people, however, a Learning Disability is NOT a choice, you can't eat right and exercise and then you will miraculously be able to distinguish your b's from your d's.
    At one point, Gastric Bypass was added as a covered benefit. I am looking for guidance to have children in need, tested and diagnosed. How can I request that these tests become a covered diagnosis.

  17. I find 10% totally reasonable because lets face it the insurance company is only paying the provider 10% of the total bill. So the family pays their premiums, and 10% of the cost and the insurance company pays 10% of the cost.

    Expecting the federal government to foot a half a million dollar bill for one member of an active duty family without the family having any real skin in the financial part of the game is unreasonable. Of course everyone wants the best care for their family but that comes at a cost, one that should be shared among all those involved.

    The bigger more important picture is how messed up health care in this country is that providers bill $100 for a service they expect to be paid 20 for instead of billing 20 and getting paid 20

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