Retired Navy Corpsman Lloyd Tilch Sr., his wife Debbie and their chronically ill son Cody pulled up roots last month in Blythe, Calif., and moved into a rented house 110 miles away, near the Marine Corps base hospital at Twentynine Palms, Calif.
The Tilch family had to move — and had only 11 days to do so after opening a letter from their Tricare support contractor — to remain eligible for the military’s managed-care network, said Debbie Tilch.
As many as 190,000 Tricare Prime enrollees across the United States have received similar letters. They advise that Tricare is enforcing a rule requiring beneficiaries enrolled in Prime at a military treatment facility to seek a waiver, either from the facility commander or Tricare Regional Office, if they live more than a 30-minute drive, or 40 miles, from the base.
Debbie Tilch sought a waiver for her family but was turned down. Suddenly she faced a difficult choice: move her family within 30 minutes of Twentynine Palms by July 20 or see coverage end effective Oct. 1. Without Prime, the family would have to rely on Tricare Standard, the military’s more costly fee-for-service insurance option.
Many families who received these letters did get a waiver. Others were denied waivers but have decided to allow prime enrollment to end rather than more families nearer to a base. But Debbie Tilch said her family has so many health problems that retaining prime coverage outweighed her desire to stay in Blythe near to other family member and friends. Three older children have careers there or have started their own families nearby.
But given that her youngest, Cody, has been hospitalized 19 times in the past year alone, and that husband Lloyd, 50, can’t work because of his own fragile health, Debbie worried that staying in Blythe under Tricare Standard would be unaffordable and dangerous.
With Tricare Standard, her family’s out-of-pocket costs every year quickly would hit the $3000 catastrophic cap that protects retirees. But more worrisome was the prospect that 11-year-old Cody, coping with “three life-threatening health issues,” might lose access to Prime specialists who have been treating his epilepsy, diabetes and weakened heart for years.
No Tricare policy official was available to discuss the wholesale enforcement this year of the 30-minute rule across the system. Austin Camacho, spokesman for the Tricare Management Activity in Falls Church, Va., did explain in an e-mail that the decision, which was made in January, flowed out of a concern for assuring quality care to beneficiaries.
“The change was made after research confirmed a direct correlation between proximity of medical care and quality of medical care,” Camacho wrote. “We determined that to optimize their health care, our beneficiaries need to have a primary care physician near their homes.”
Debbie Tilch said her Prime providers on base are terrific. But she doesn’t accept the notion that forcing beneficiaries to live nearer to base will result in more timely care or higher quality care. Cody still is being referred to specialists for his various ailments as far away as San Diego and Los Angeles, long commutes from either Blythe or Twentynine Palms.
In her view, Tricare is enforcing its 30-minute commute rule now to save money by forcing more retirees to use Standard. She noted that under Tricare Standard, if Cody or Lloyd have to be hospitalized in a civilian facility, her family’s cost would be $535 per day or 25 percent for institutional services, whichever is less, plus 25 percent for separately billed professional charges. Under prime, retiree families pay only $11 a day.
“When they pass the Obama health care plan,” Debbie Tilch asked, “are they going to tell those people where to live?”
Military beneficiaries, she said, deserve better than this.
To comment, e-mail milupdate@aol.com, write to Military Update, P.O. Box 231111, Centreville, VA, 20120-1111 or go to www.militaryupdate.com.
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