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Old 04-07-2018, 12:28 PM
 
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I personally have noticed less specialty and regular PM doctors and clinics in San Antonio are accepting new Tricare (Prime or Standard) patients while they have room for new patients with other main insurances. They will specifically say "we are not accepting new Tricare patients at this time". When asked if they accept other "X" main insurances, the answer is yes.

If true this would be an absolute shame as this insurance is a primary insurance for veterans. The ones who are not comfortable going to the VA. The ones who fought, where injured and some died serving all of us. So they are vulnerable and need help. One only has to watch the news to see the quality and wait times for VA healthcare to know why vets are turning to other avenues.

This has been what I have been seeing but it may not be what is actually occurring here in San Antonio. Perhaps you work at a doctors office or clinic, or in the medical insurance field overall and can see the stats and can confirm or deny this. The more answers the better as your particular office (some) may still accept existing Tricare patients (or even some new ones) but there may still be a downward trend of not accepting new Tricare patients.
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Old 04-09-2018, 05:39 AM
 
Location: Boonies
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txbullsfan, I think Tricare Standard is now Tricare Select managed by Humana. I know in the practice that I manage back here on the east coast, I had to reenroll my provider. Of course, that is most likely not the issue in SA. I also know that the reimbursement to physicians are low compared to other commercial insurances.

You should call Tricare or go online to find participating physicians. I believe you just enter your zip code and the specialty you are looking for and a participating list should come up. Good Luck!
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Old 04-09-2018, 01:49 PM
 
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Quote:
Originally Posted by tarragon View Post
txbullsfan, I think Tricare Standard is now Tricare Select managed by Humana. I know in the practice that I manage back here on the east coast, I had to reenroll my provider. Of course, that is most likely not the issue in SA. I also know that the reimbursement to physicians are low compared to other commercial insurances.

You should call Tricare or go online to find participating physicians. I believe you just enter your zip code and the specialty you are looking for and a participating list should come up. Good Luck!
I appreciate your response Tarragon.

I have gone online and reached out to participating physicians. In my search, about 60% - 70% are not accepting new Tricare patients at this time but they are accepting other insurances, which is why I made the OP. I feel that it is insurance discrimination against veterans with this insurance.

I was curious as to if anyone else was seeing this (a decrease in the number of participating providers accepting Tricare and of those remaining participating providers, even less are accepting new Tricare patients).
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Old 04-09-2018, 04:29 PM
 
Location: Texas
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If it is managed by Humana, that might be the problem. Doctors are dropping Humana due to the reduced amounts they are paying but mostly because they are now requiring the doctors offices to have the Humana program on their computers to bill them. Obviously, for some doctors offices who are not Internet bound and not totally computerized, this is an unwanted expense. I have Humana Medicare Supplement and my doctor will not accept any more Humana patients. He is converting as many as he can to other insurers. For me, being diabetic, means I can change Medicare Supplements at any time. For many, they can't change until enrollment opens in October.
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Old 04-09-2018, 04:40 PM
 
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Medical providers have to make money and if tricare is not making that possible for them, it isn't the provider's fault for what is happening.
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Old 04-09-2018, 07:40 PM
 
Location: Boonies
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Quote:
Originally Posted by txbullsfan View Post
I appreciate your response Tarragon.

I have gone online and reached out to participating physicians. In my search, about 60% - 70% are not accepting new Tricare patients at this time but they are accepting other insurances, which is why I made the OP. I feel that it is insurance discrimination against veterans with this insurance.

I was curious as to if anyone else was seeing this (a decrease in the number of participating providers accepting Tricare and of those remaining participating providers, even less are accepting new Tricare patients).
We get phone calls from insurance companies now and then on behalf of a subscriber to inquire about accepting a new patient. For us when we have to do a mandated update to continue participation in a particular insurance carrier, we have to specify if we are accepting new patients. That information should be available online for people looking for a provider. It's all nuts. I've worked in healthcare for 29 years and it has changed so much.

Maybe you should call Tricare to see if they will assist you in finding care.
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Old 04-10-2018, 07:25 PM
 
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Quote:
Originally Posted by tarragon View Post

....Maybe you should call Tricare to see if they will assist you in finding care.
I have regarding finding a specialty, as I have and am not seeking a general PCM doctor. Tricare's statement is I must get a referral from my PCM. My PCMs statement is everyone they refer out to on a regular basis is not accepting new Tricare patients at this time. So I am stuck in a loop.

The specialty clinic is not a one off clinic as there are many doctors here in San Antonio that deal with the specialty. In fact, these doctors, as stated earlier, are accepting new patients at this time, just not new Tricare patients. Also, when I check this specialty field on Tricares website, the doctors have almost all completely changed and that has happened a couple of times. Then, when I personally call the specialty office, they state they are not accepting new Tricare patients at this time. So back to the PCM and round and round. PCM's looking. I am looking. Still havent connected yet.

Quote:
Originally Posted by Azure110 View Post
Medical providers have to make money and if tricare is not making that possible for them, it isn't the provider's fault for what is happening.
Making money and not taking a loss are two completely different things.

One thing I have learned about Medicare, Medicaid, Tricare and such is that unlike big, extremely profitable and lucrative insurance companies that charge insane amounts of deductibles and have insane co-pays and incredibly high monthly rates for a large portion of people, Medicaid, Medicare and Tricare actually research what the costs are to the doctor/office/hospital and pay those costs. I suppose thats why some docs poo poo Tricare, Medicare and the like. Tricare and Medicare know that Tylenol pill is not $5 even though the office/hospital bills the insurance this. They know that single wetnap is not $1.50 and so on and so forth. Tricare and Medicare are good at knowing true costs, not paying overinflated charged costs.

There is often a huge discrepancy between what an office/hospital charges and what they actually get paid by the insurance.
Hospital Billing - True Cost of Heathcare

I supposed when an extremely lucrative large medical insurance company (United, Blue Cross Blue Shield etc.) is gouging a large portion of its paying insurance customers (either the customer directly or a combination of the customer and the employer) through the teeth, these lucrative insurance companies can afford to pay whatever (or close to) what the office/hospital is charging without balking too much. That indeed would create a huge discrepancy in payments made if one chose to pay costs or slightly over and the other paid what is being charged or close to it.
http://truecostofhealthcare.org/hosp...cial_analysis/

I suppose it is profit over everything now adays. Unfortunately, that mindset may indirectly relate to denying veterans care in many civilian places. Hospitals/offices/doctors providing that care may have (or be getting) the mentality of taking payment where I dont incure a loss but I also don't make a lot of profit, or at least profit over actual costs is not ok or acceptable, despite the fact that I am making a large portion of profit off of the other large lucrative other insurance providers. So instead of doing that, I will just not accept new Tricare patients. That is a real shame if that truely what is happening. If that is truely what is happening it would be sad how greedy the medical field has been and is becoming. Both on the medical insurance end and on the provider end.

Perhaps I am wrong and if someone has a better explanation of what is going on, I am open to hearing it. I am sure not every doctor or office is like this. I am sure there are good doctors out there where large amounts of profit is not the ultimate goal. Its possible that large amounts of money and profit as the ultimate goal may be making that group smaller and smaller.

Last edited by txbullsfan; 04-10-2018 at 07:42 PM..
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Old 04-10-2018, 08:24 PM
 
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So whenever my PCM (at Camp Bullis) gives me a referral, that referral goes to Humana and they tell me which specialty clinic I go to. The PCM doesn't decide who you get referred to. I've never once had to hunt around for my doctor, nor has my wife. I'm talking specialities like ortho, endocrinology, pain management. There are some case when we can get into BAMC or Wilford Hall, but if they aren't available we have been able to see an outside specialist without delay. I'm Prime, BTW.
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Old 04-10-2018, 09:01 PM
 
1,514 posts, read 876,985 times
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Quote:
Originally Posted by Rustybolt View Post
So whenever my PCM (at Camp Bullis) gives me a referral, that referral goes to Humana and they tell me which specialty clinic I go to. The PCM doesn't decide who you get referred to. I've never once had to hunt around for my doctor, nor has my wife. I'm talking specialities like ortho, endocrinology, pain management. There are some case when we can get into BAMC or Wilford Hall, but if they aren't available we have been able to see an outside specialist without delay. I'm Prime, BTW.
Same here. Prime. I dont know how it normally works but that it just does automatically usually for me as well. I go to PCM, PCM says I'm referring you. I wait a few days and I get a nice phone call from the specialty. I haven't once had to hunt before this either and Ive had Prime for close to 10 years now so I too am surprised by whats going on.
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Old 04-11-2018, 06:58 AM
 
Location: San Antonio
7,629 posts, read 16,347,461 times
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Your quote:

I have regarding finding a specialty, as I have and am not seeking a general PCM doctor. Tricare's statement is I must get a referral from my PCM. My PCMs statement is everyone they refer out to on a regular basis is not accepting new Tricare patients at this time. So I am stuck in a loop.

BINGO!!! The problem is the PCM!!! You need to go to the Patient Advocates office for that facility (where you see your PCM) and explain your needs and the PCM's refusal to place the referral, and then request, in writing, the "standard of care" timeline that has to be met (according to the "status" of the need, it varies), and that means they have to either get you seen by whatever specialist is deemed relevant to the situation, OR they have to pay to get you seen "outside the system". TRUST ME, as a retired nurse with years and years of experience at military hospitals all over the world, I PROMISE you they will "find" someone that can see you within that required "Standard of Care" window! Let us know how that works out for ya! Sad, but sometimes knowing the system from the "inside" is insightful when caught in the cogs of the wheels.......
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