I have standard. I’ve very happy with it. I pay some out of pocket, but really not very much.
We have standard as well and it has been great for us. I constantly hear from prime members about the restrictions and choice of Doctors and how they are treated.
We do reach the retiree cap per year due to our son’s Kidney/transplant situation, but I wouldn’t trade our doctors and the outstanding service they provide to us, for anything. And Tricare has been wonderful when it comes to approving medicines/procedures.
I’m glad you are able to use Tricare standard, but if you lived in the Philippines you would be mandated into a modified Tricare Prime. I won’t go into the weeds on it except to say that the guarantee of Tricare being a choice of Standard, Extra or Prime is being removed from us and we are being forced to use a very limited number of providers, many of whom are substandard or are quacks that retirees refuse to voluntarily use. See my earlier post; http://www.freerepublic.com/focus/f-vetscor/2943197/posts
Here is a letter I wrote to a journalist that had requested our input on the Triccare Philippine Demonstration Project;
Mrs. ********;
I understand that you are getting close to putting your article on the Tricare Philippine Demonstration Project to bed.
I would like to direct your attention to a situation that will illustrate that TMA/ISOS will dramatically limit access to quality medical care in the Demonstration Project area(s).
If you will look at the areas that TMA/ISOS have identified as phase 1 you will see that Orion, Bataan is one of those areas. I have been told by a TMA representative that from his understanding of the network being set up in Orion by ISOS that ISOS will establish the boundaries of the Orion network as the political boundaries of the Municipality of Orion. In other words, the Municipality borders as designated by the Philippine government.
Assuming that the boundaries are set as described above, and using the criteria stated by TMA in the Federal Register posting of September 2011 and the outline of the Demonstration Project printed in the Tricare Operations Manual, ISOS will be required to contract with a hospital within the Orion Municipality borders. All Tricare beneficiaries living within those boundaries MUST use only the network contracted provider(s). This then presents a glaring issue of lack of access to quality medical care, as I will describe below.
Orion is a municipality in the Province of Bataan. Wikipedia says;
Orion is a 2nd class municipality in the province of Bataan, Philippines. According to the latest census, it has a population of 49,164 people in 8,735 households.
According to the 2005 MUNICIPALITY OF ORION, BATAAN
ECOLOGICAL PROFILE, Orion has 1 hospital;
“Within the municipality, there is 1 hospital (Orion St. Michael
Hospital) with a total bed capacity of 19. In addition, there
are six (6) private medical clinics, 1 rural health unit and 13
barangay health stations. At the outskirts of Orion, there is
the Bataan General Hospital located in Balanga City.”
According to the Philippine Government PhilHealth, St. Michael Hospital is a level 2 hospital. A level 2 hospital is defined as;
“Level 2 Hospital
- Non-departmentalized hospital
- general medicine, pediatrics, surgery, anesthesia, obstetrics and gynecology, first level radiology, secondary clinical laboratory, pharmacy
- nursing care for patients needing intermediate supervised care”
Because TMA has made it clear that beneficiaries residing within the network boundaries must use the network providers, Tricare beneficiaries living in Orion will be required to use a hospital that is unable to provide the medical care that elderly U.S. military retirees and their families require and have earned by their service to the United States.
In the information that I referenced above, it is stated that just outside of the Orion boundaries there is a Philippine Government Hospital, (Bataan General Hospital, a 350 bed hospital that caters to the extremely poor and the low income population). But since this is a Philippine Government Hospital, it has a few private pay rooms or private pay semi-private rooms. Most Patients are placed in wards, usually 20-30 beds each, (according to one nurse’s resume on the internet, the surgical ward is a 15 bed ward).
(The retirees in Bataan tell me that this hospital is horrible. They say that you go in on a stretcher and come out in a hearse).
The patient is required to have a “watcher”, (usually a family member that stays with the patient 24/7 and is responsible to contact the nursing station if the patient has a medical issue. The watcher also is required to go to the pharmacy to purchase the medicines prescribed. In many of the General Hospitals the watcher will have to clean the restrooms, (which will have a commode without a seat, a bucket of water to flush the toilet and for showering). Patients are frequently required to bring their own bed linens and meals.
Obviously, the Bataan General Hospital is not a hospital that meets the Tricare Manual standards for hospitals, and since it is a government hospital, there is no way that TMA/ISOS could get this hospital under contract with the Demonstration Project.
In the Provincial capital, (Balanga, population 91,059 as of December, 2010), which is a 15-20 minutes’ drive from Orion, there are 4 hospitals, Bataan Women’s Hospital, (a level 2, 30 bed hospital), Bataan St. Joseph’s Hospital, (a level 3, 18 bed tertiary hospital), Isaac Catalina Medical Center, (a level 3, 90 bed hospital), and Bataan Doctors Hospital and Medical Center, (a level 2, 25 bed tertiary hospital).
The beneficiaries in Orion will travel to Balanga, Bataan to use Isaac Catalina medical Center for moderate to critical medical care, but, under the demonstration Project, will be restricted to the 19 bed, level 2 hospital in Orion. Failure to use St. Michael Hospital in Orion will result in the beneficiary being forced to pay 100% of the medical bill with no chance of being reimbursed.
The question that needs to be asked is; why did ISOS pick Orion, instead of Balanga, to be the Demonstration Project network area? Our opinion is that ISOS was unable to get any of the hospitals in Balanga to agree to be a Demonstration Project network provider and that since TMA had identified Bataan to be one of the areas to establish the Demonstration Project in, ISOS had to find a hospital willing to contract with them. Unfortunately, Orion St. Michael Hospital was the only hospital willing to take a chance with Tricare.
The beneficiary will be denied adequate, quality medical care based on this decision and their health will be placed in jeopardy.
I have Prime and am taking chemo and then radiation. I don’t want Standard especially right now! I need the low copay of Prime. Of course thank the Lord I am not in this area and am keeping my Prime (for now)