At a recent doctor’s visit at the Marine Corps Air Ground Combat Center base hospital in Twentynine Palms, Calif., Lt. Christy Kercheval learned she needed a magnetic resonance imaging (MRI) procedure done.

Since the Robert E. Bush Naval Hospital on-base does not have an MRI machine, the doctor’s office told Kercheval they would instruct her on how to proceed off-base. A short time later, she received a letter in the mail.

“TriWest sent a letter to my house giving me authorization for the MRI, the phone number and name of the place I was supposed to contact to schedule the MRI,” Kercheval said. “I brought the authorization letter with me (to the appointment) which they kept on file.”

The procedure, done at Valley Imaging Center in Apple Valley, will be covered by Kercheval’s TriWest insurance, which is provided through the Defense Department’s TRICARE military health system.

The scenario offers anecdotal evidence of why quality civilian health care options are vital to military members and their families — whether they live on the installation or off. It is also a good example of how the military’s health care connection with civilian doctors should work.

The past several years have seen many military hospitals scaled back or closed completely due to the Base Realignment and Closure (BRAC) process. This fact alone has dramatically boosted military families’ need for civilian health care options.

Additionally, military doctors are among the service members currently deployed for Operation Iraqi Freedom and Operation Enduring Freedom, and this has led to short-term deficiencies of doctors on bases around the country — another testament to the need for civilian health care options.

Civilian heath care providers are especially essential when it comes to specialized treatment needs.

“It would be cost-prohibitive for a small treatment facility such as this to maintain a varied staff of specialists to take care of every possible medical need of our population,” said Dan Barber, public affairs officer at Robert. E. Bush Naval Hospital. “The Bureau of Naval Medicine and Surgery establishes the type of medical services Naval Hospital Twenty-nine Palms will provide in-house. To meet the specialty care needs of our patients, we need to have a qualified network of health care providers to refer to patients when their care exceeds our scope of care.”

In the big picture, military families can do one of a few things. They can use their TRICARE benefits to receive care at little or no cost at military installation hospitals. They can also visit a TRICARE-network civilian health provider or facility, for little to no cost.

Military families also have the option of using any non-network civilian health care provider they choose; however, they are responsible for the associated costs pertaining to that care.

For service retirees, CHAMPUS (Civilian Health and Medical Program of the Uniformed Service) offers partial reimbursement to civilian health care providers. Some Shortcomings

with TRICARE Insurance

As far as health plans go, by all accounts the TRICARE military health care system is a pretty good one, but challenges still exist.

For example, when it comes to finding care in civilian communities, the challenges don’t stem from lack of care options, but rather from finding civilian doctors that accept TRICARE.

“The range of doctors in any given community is not the problem — it is the number of doctors who will accept TRICARE payment,” said Kathleen Moakler, deputy director in the government relations department of the Virginia-based National Military Family Association. “The best-case scenario is for the military family to have as little out-of-pocket expense as possible. If the doctor is in the TRICARE network, the doctor agrees to take the TRICARE allowable amount as payment. As this is tied to the rate for Medicare, many civilian doctors decline to sign up for the network.”

In the current wartime climate, National Guard and Reserve members face a host of challenges, not the least of which involve health care issues. Perhaps the situation is a little more distinctive because Guard and Reserve members frequently live in communities that are nowhere near a military installation and they typically must rely on civilian health providers.

Take for instance, the story of Brian Smith*. A National Guard member for more than 20 years, he was called up in March 2003 to serve for a year in Kuwait. The moment his orders to deploy were official, the manufacturing company where he was employed dropped his — and consequently his family’s — medical insurance.

Brian’s spouse picked up insurance through her employer and used TRICARE as a secondary insurance provider.

Lisa Smith* explained that living in a civilian community, nearly an hour away from the nearest military installation, left her feeling like she was out in the cold.

“On-base, everyone is in the same boat,” Smith said. “But to exist as a military family in a civilian community, especially when you never have before, is tough. This life is no bed of roses for people who are thrust into it.”

She felt especially challenged when she went for medical appointments armed with her own insurance — as well as the TRICARE insurance — and was met with some disfavor.

“They acted like I had the plague when I showed them my military insurance card, even though I also had primary insurance through my company,” Smith said of the civilian providers.

Ultimately, the providers told Smith they did not accept TRICARE.

For other active-duty military families, civilian care is in order because of TRICARE’s space-available design.

Waiting lists, even for urgent-care appointments, stack up quickly at time- and staff-pressed military hospitals. Yet, pitfalls still exist when these families make doctors’ appointments in local communities.

At Fort Hood, Texas, the nation’s largest military installation, around 105,000 personnel are enrolled with Darnall Army Community Hospital as their Primary Care Manager, and about 16,000 military beneficiaries have chosen a civilian provider as their Primary Care Manager.

“Almost all of the civilian providers accept TRICARE,” said Gerald Skidmore, assistant to the president of the Greater Killeen Chamber of Commerce in Texas. “The only concern from time to time is they may have to periodically ‘close their panel’ because of the TRICARE numbers exceeding their plan capability.”

Health care programs everywhere are peppered with good and bad points, and the military’s TRICARE plan is no different.

Ultimately, what matters most is that military service members and their families receive timely and adequate health care, and at affordable costs. Civilian doctors are essential to making this happen.

“We rely on a network of civilian providers and hospitals to fill in the gap caused by shortage of health care providers and nurses,” said Jeri Chappelle, public affairs officer at Fort Hood’s Darnall Army Community Hospital. “Without this network, our hospital would not be able to provide health care to all the beneficiaries in our community.”

Rachael Hedgcoth is a freelance writer based in Overland Park, Kan.