I just PCS'd to a new duty station that is not within a reasonable distance to a military treatment facility. As such, I have to be assigned to Tricare Prime Remote, meaning I need to find a civilian provider who accepts Tricare. Simultaneous to this occurring, I injured myself playing sports, and its relatively debilitating. I cant run (something I normally do every day), it hurts to walk, to stand up, to get in and out of my vehicle, etc. The injury occurred over 2 weeks ago and is still present. After the first few days of it not getting better I decided to pursue medical treatment realizing it was more serious than originally thought. Here has been the insanity I have gone through.

-Call Humana Military to ensure I am assigned to Tricare Prime Remote. Get assigned to a civilian PCM in the local area. I specifically ask "I have an injury...do I have to see the PCM first for a referral or can I just find a specialist?" I am told I can make an appointment with a specialist directly.

-Call a specialist, they schedule an appointment.

-Specialist calls me back a few hours later, says that they cannot see me without a referral because that's what Humana is telling them.

-Call Humana back. This time they say "Oh yes, you have to see your PCM first. I dont know why someone told you that you could go directly to a specialist." Great, now I need someone to verify that my leg hurts before getting seen for leg pain.

-Try calling the PCM I was assigned. For hours. Phone just rings and rings. I search online, and the practice seem to have been bought out or something. Tricare had assigned me a defunct practice and there is no other info on the doctor himself that I can find.

-Go to Humana's website to search for a PCM. Spend literally hours going through the list they provide for my area because each one I call is either out of business, not accepting new patients, or incorrectly listed (ie, they're in pediatrics or something).

-Finally find a practice that can see me. I set an appointment but the soonest they can see me is another 5 days. Great, 5 more days of pain.

-Go in yesterday to be seen. Doctor confirms, "Yes, your leg does hurt. Here's that referral you want." Great.

-I call back the original specialist and set an appointment again. They say they cannot see the referral in whatever system they use so I email them a copy.

-The doctor I had seen earlier calls me and says "We cant put the referral in the system because Tricare doesn't have us listed as your PCM. Call them and update me as your PCM and we can take care of it."

-Call Humana. Tell them to update the PCM. 30 minutes on the phone...and they cannot find him in their system. I tell them I originally found the practice through their own website. They say that they cant find it any longer. I will need to find a new PCM that is in their system, and start over again. She gives me a list of 4 to call and try. She says once I find one that will work, call back and have them update the PCM in the system.

-Call the first one on the list "I'm a pediatrician, I don't see adult patients."

-Finally get a hold of one. In the local area. Accepting new patients. On the Humana Military PCM list. Great, everything should be set. Make an appointment for Monday.

-Call back Humana. "Ok we can update that PCM. It wont go into effect until next week though." I tell them I have already made an appointment for Monday. "Oh, they wont be able to see you until the system reflect them as your PCM."

My leg hurts. It has now been weeks of it hurting, something is likely torn. And after all of this crap I have already dealt with, I am at least 4 days away from even being able to make an appointment, which will likely be days away from being seen, just to verify that my leg is hurt, and then to make ANOTHER appointment with someone who can actually do something to try and fix it.

This system is beyond insane.

Make sure you keep copies and timelines of all of it for when you get out.

Can you not get a few days off from your CoC and just drive to a military base somewhere and go to sick call? At this point it seems like that would be a better bet than waiting around on this bullshit.

Hell I'd even go so far as to see if there's an avenue of complaint about this somewhere with teeth.

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Hell I'd even go so far as to see if there's an avenue of complaint about this somewhere with teeth.

Congressperson?

That was a painful read. I can understand how you feel trying to sort this all out while in pain.

I'm on Tricare for Life. 8 years ago I encountered a similar "goat rope" trying to get a specialty medication filled. Found a half dozen of we Vets being seen at the regional cancer care institute were having the same issues.

Said "screw this" and contacted my US Senator's office. Had things resolved in two days for all of us. Been smooth sailing since.

I'd recommend the same course of action for you. Have a succinct unemotional summary of what you're encountering to provide the Senator's staff.

Bureaucrats. Bastards.

Hope you can get somewhere with this. Is there an ombudsman on base who can help? Some Colonel or General, maybe? Congressman isn't a bad idea, either.

Humana is the problem as they apparently have the contract in your area. Being Tricare Remote adds to the difficulty as there are fewer doctors to choose from. Needing a referral in your situation is ridiculous, but standard.
Doctors have to jump through similar hoops and are paid at low rates. All of these lead to a broken system.

Tricare for life is less of a problem as Medicare has already paid most of the bill. BTW make sure the referral is to an orthopedic specialist who treats adults.

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Humana

I suspect this is the crux of the problem. Do you have alternatives?

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Originally posted by joel9507:

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Humana

I suspect this is the crux of the problem. Do you have alternatives?

Nope. Humana handles the Tricare East region. I am stuck with them.

As for the person who suggested I drive to a base...I know what you're saying, but the only people who rival Humana's incompetence are any people who work in military medicine. At least in the end of this nightmare process Ill see a competent physician.

Jester already said it, but I would hate for it to go unnoticed. DOCUMENT EVERYTHING THOROUGHLY (timeline, conversations, summary of the runaround) AND SAVE IT FOEREVER.

It won't help you now, but having all of that documentation at your fingertips if this turns into a chronic issue because the military jerked you around will help you get care for it later.

It pains me to say this, but that is one argument (not one that I'm making) for government run "free" health care. Getting in network care and understanding billing are a major PITA.

Mrs. Sigmund handles the billing, we're in very good shape as Medicare is primary and Tricare For Life typically pays the remainder.

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Mrs. Sigmund handles the billing, we're in very good shape as Medicare is primary and Tricare For Life typically pays the remainder.

^^^^^^^^^
Tricare for life has WPS for their fiscal intermediary. They are not easy to deal with from the provider's point of view. The chat line cannot answer simple questions and they do not answer the calls. TFL is not free government healthcare and it is certainly no model.

Under tricare you should be able to go to the neatest ER/urgent care office. The doc there will make the referral and tricare will cover the costs and process the referral as if from your PCM.
2 things
-get a hard copy of the referral in case the ER can't or doesn’t enter it into the tricare universe. You can fax it to them youself.
-call tricare after you have been seen. There is a requirement to follow up with your PCM within xx number of days. You will need to call tricare directly and have them document the follow up since you don't have a PCM. At woast, they may require you to call who ever is listed as your PCM in the system and report the visit.

You may want to double check to make sure that you fall under the same rules because, you know, tricare….

Our PCM is at the clinic at Mayport and Naval Hospital Jax is about 40 away mile and We use the civilian ER/urgent care for any injuries/illnesses that we don't want to wait around to get in to see our PCM.