For military folks, you’ll be able to relate to our story best. My husband is active-duty Air Force, and we are covered under Tricare. His dependents (the kids and myself) were enrolled in Tricare Prime meaning our coverage was free but we had to see a military primary care manager. I always took the kids to the base every time they needed a checkup. It was nice because it was free, but options were restricted.
After my diagnosis, we had to deal with the fact that I was away from a military base and couldn’t see my PCM at the base. The fix for that problem is to obtain a referral, but those take time and there are often delays in the communication between offices. So, we often showed up to the hospital at IU and had trouble with insurance. The first day that I showed up for my first chemo infusion, the pharmacy wouldn’t bring the chemo because insurance hadn’t been approved. Mark signed a waiver saying he would pay out-of-pocket if the insurance didn’t come through. The cost of one chemo chair for 4 hours is approximately $28,000 dollars! Anyhow, Tricare Prime was a pain-in-the-butt while we kept it.
Eventually, we got fed up with the referral process. Every appointment and every set of scans had to be approved individually, and it was difficult to keep up with the flow. After a few months, we switched my plan to Tricare Standard. Standard requires the family to pay for the first $1,000 of costs each fiscal year, but that is the cap and everything after is covered. It’s a family cap too, so once the cumulative cost of anyone in the family reaches $1,000, everyone’s is covered. The major benefit is that we no longer needed referrals. As long as Tricare was accepted by the provider, we were approved and good-to-go. Instantly, our insurance stresses were over. I’ve been on Tricare Standard for about a year now, and we haven’t paid a cent over the $1,000 max. The process couldn’t be easier switching between clinics as well. I’ve switched doctors three times since I changed to Standard, and I’ve had no trouble. Occasionally, a bill shows up requiring a co-pay, but they are usually cleared up with one phone call.
I understand that many people struggle when dealing with the stresses of having cancer and having a difficult insurance company. I know there are appeal processes for those having trouble, but my recommendation is to plan ahead and make sure medical insurance is top quality in case you find yourself in a situation like this. You just never know.