Saturday, April 25, 2015

A Post Update (Insurance, Ugh.)

In my post on the pros and cons of retired life here, I said that we hadn't quite figured out a good fit for medical care.  We opted to use the US Family Health plan after I retired, a Tricare provider managed by Johns Hopkins available in the DC area.  We are generally a healthy bunch, so despite our dissatisfaction, I didn't work it very aggressively.  You can see where this is going, right?

My daughter, who already plays soccer and basketball and loves to ski black diamonds, took up rugby.  During a game she twisted her knee the wrong way while changing directions on a wet field - with no opposing player contact at all - and went down hard.  It was diagnosed as a severe sprain and we didn't pursue it further.  It got better, and the time off from all sports over spring break seemed to be the rest she needed.  At the first post-spring break soccer practice she went down hard again, and this time said it hurt a lot more.  Time for...

So we worked the usual the primary care physician 300 times the next morning until they answer and get a same day appointment.  They also said severe sprain, but recommended an MRI and a visit to an orthopedic specialist.  So here is where our chosen medical plan didn't work.  Our PCP referred us to people that don't take our insurance.  Nice.  So I got online and tracked down places that took our insurance...which kind of felt like picking randomly out of a phone book, but what-evs, I was all about getting things fixed.  We live in Virginia, and most of the US Family Health providers are in DC and Maryland. Then the MRI report comes in - completely torn ACL and a couple other issues.  The ortho doc agrees, and then says he is not the guy to fix it - we need a pediatric/sports medicine specialist.  The closest specialist approved by our insurance? Over an hour away.  

Let me pause in my whiney rant, to say that I recognize that this is a 1%er, 100% first world problem.  We have access to insurance from multiple employment sources, and have the means to pay a reasonable amount out of pocket.  So why did this throw me for a loop?  Maybe because this wasn't me - this was my daughter - and I wanted to make it all better.  Maybe also because I was given a rule set that didn't make sense and didn't allow me to figure out a reasonable solution.  And finally, because when finding someone to perform SURGERY on your kid, I didn't like picking a random name off a list.  We wanted to go to a doc that people we trusted knew and recommended.

Let me pause also to say that US Family Health is not the bad guy in this scenario.  I have lots of friends that use it and love it. Their ombudsman, who my husband is on a first name basis with now, was a wonderful help - but it just wasn't the right solution, especially for all the reasons above.

So here is the good news - and why I wanted to write this post: YOU CAN CHANGE YOUR TRICARE STATUS AT ANY TIME. This is what saved the day.  You don't have to wait for any kind of enrollment window or stick with any particular plan for a minimum amount of time.  AND - you can pick different plans for each member of your family.  This might be completely obvious to most military families, but as a dual military couple we frankly didn't deal with Tricare and insurance very much at all.  Three of us are now Tricare Prime, assigned to Fort Belvoir, who is currently accepting retirees (not always the case, as active duty obviously gets priority).  My daughter we could enroll in Tricare Standard, so we could go to the docs and physical therapists in our neighborhood that were highly recommend.  We have to pay co-pays, and 20-25% of services, until you reach a $3,000 cap.  We could have enrolled her in Prime, but then would have had to work through referrals, and again, we were all about finding a fix and getting the process started.   

Result:  She had the surgery last week, PT is lined up for Monday, and she will probably go back to school, albeit on crutches, Monday.  We can use the summer to rehab so that she an be ready to join her teams for the next school year.  It's what she loves, and I'll use Mama Bear Mode to make it happen :-)

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