Wednesday, July 30, 2008

Confusion

The older I get the more things I run into that make me go huh?

I am in the process of getting Evan set up with a pediatrician. I have been a bit lax about it due to the move and settling in and potty training but we really need to get his health care system set up and in place so that he can start physical therapy again among other things.

Where I am running into problems is that there are pediatricians aplenty that take Tricare, however none of them are considered primary care managers by Tricare. There are also loads of family practice doctors that take Tricare. Guess what! None of them are designated PCMs either. In fact there are no PCMs in a 50 mile radius! How insane is that?

We, of course, have been on the phone questioning this apparent oversight but it is hard to get things done when you get a different answer every time you call. What I don't get is why are not family practice doctors and pediatricians not automatically designates as PCMs? When it comes to the doctor food chain they are the lowest on it. It only makes sense.

I guess that is where I go wrong, assuming that an insurance company would do anything that makes sense. Another thing that puzzles me is that my husband's coworkers have doctors. Why is it only now that we are not able to get one? I can feel my head starting to ache.

I know that we will eventually get a doctor set up for the kids and us. We will be very squeaky wheels, I can promise you that much.

11 comments:

chelle said...

The system is an odd one. You have the experience to fight for what you need so that will play in your advantage! Good luck!

The Woman said...

pft is that the loophole to get the insurance out of paying for it. They find a way around everything don't they

Karen (Pediascribe) said...

lowest on the food chain....

heh. you have no idea how low they are!

Guinevere Meadow said...

Insurance? Making sense??! HAHAHAHA!!!!!! Legalized extortion, if you ask me...

Anyhoo. I'm sure you will find the right person to take care of your family's medical needs, praying that it won't take you too long to find him/her!

Heather said...

I make my husband do all the health care insurance calling, etc. It makes my head want to explode.

Zephra said...

Insurance companies rarely make sense. Why start now. I hope they work wit you to get it right.

Gina said...

Squeaky wheels get all the grease, for sure!

Our health care system bites the big one.

My Full Hands said...

*Chuckle* Health care making sense? I still can't figure out why our insurance doesn't cover birth control. Surely it's a lot cheaper than adding a whole new person to the plan. Cheapskates.

Tama said...

OH! Don't even get me started on the intelligence level of insurance companies! I don't know what realm of reality they exist in but it is NOT the one I live in.

happy mommy said...

We recently switched to TriCare and it is such a headache trying to get people to be consistant in what they tell us. (no co-pay, yes co-pay, for one example)

Say what you want about Kaiser...at least when we had it there was never any grey area about where, when and how much.

I hope you figure it all out soon!

Dr. Cason said...

The question really is whether you have Tricare prime or standard.

Prime means that you are treated exclusively by the military docs and you pay nothing. BUT if they don't have the services available or are overrun with patients and can't serve you in a timely manner (like with most peds) then you request to be "serviced out". When you are serviced out you get the initial authorization to go and then they will cover ALL the expenses that are incurred at that office. Just find your person ask if they take tricare then call tricare and ask to be authroized to go elsewhere. Give them the name and have them change the PCM on your DEERs account.

If you have standard then it's a mute point. You choose who you want and then pay a co-pay everytime you go.

I have always had Prime and asked to be serviced out. Which has always been approved because peds is so busy with the military.

I hope this helps.

Thanks you awesome mom for visitng me frequently. God bless- Sheila