Tricare Medical Benefits - what you need to know

Alright. I am now stepping into the whole health care issues because everyone needs to know our reality and what is going on with us. Tricare Prime - yes it is a good thing in theory, but here is our reality. Tricare doesn't pay the providers enough. Around here, doctors are dropping it right and left. We noticed that our GI doctor (the one that didn't want to treat Mike anymore) is no longer on the list. He was ranked as one of the best GI doctors in DFW Area. We have been trying to find a replacement, but pickings are thin both in local area and in experience. Now, we get a call that Tricare is not paying Dr. Khan his COST on the drugs that we use. So all this time, every time they treat Mike, they are losing money. Not even breaking even. Now, on a very real world level, why would you want to treat anyone like Mike? Think about that. Is this the kind of insurance that America wants for the men and women that serve them?

Dr. Khan is still seeing Mike as a patient but now the rules have changed. As Mike stated, "This is hard enough, now it is even harder." We now have to order our White Blood Cell booster, Neuprogen, through the Speciality Pharmacy and have it delivered to our house. We then need to hand carry it to the Doctor in case Mike needs it. Chemotherapy? We now have to go to the hospital for our Chemotherapy as an outpatient. So we have to go see the doctor and then drive over to the hospital, register, and do chemo there in Day Surgery.

I remember when we first started Chemo last year in the hospital. I was surprised that the hospital did it on a regular basis. She told me that she has many Medicaid/Medicare patients that do Chemo in the hospital, because their insurance won't cover them unless it is through the hospital. We are now in that category and it is wrong. It is wrong because insurance should cover the costs to the providers. It is wrong because I am sure we can get these drugs cheaper in other countries. It makes no sense to me. What is the cost of doing it in the hospital vs. at Dr. Khan's office? Now let's add the added risk of infection to Mike being in a hospital setting.

Yes, I have talked to our case manager and everyone is working the best they can. Dr. Khan is trying to renegotiate with Tricare. Our case manager said that is the cost of doing business with Tricare. They may not make money on some things. But within this circle of all the $$, there is Mike. I am trying not to panic and trying to trust, but Dr. Khan has fought for us. He is the one Doctor that won't be a time limit on Mike. He still believes that even if he can't cure Mike right now, he might be able to in a year with a new treatment. That is the kind of person you want on your team.

Here are my specific prayer needs:

1. For Mike - that we can quarantine him and keep him healthy until we get the Neuprogen. His white blood was in normal range, but he typically needs a shot by about Friday. If we can not get this delivered before Monday and his white blood numbers are low, then it puts off Chemo and everything else.
2. Mike to gain weight.. last check it was at 136
3. For everything to be resolved with the insurance/tricare etc. This is serious. I can see a few different scenarios playing out here and the worst one being we have to find a new oncologist. In the end, I may need to go back to work somewhere new where I can get insurance that will cover us here in the DFW area. Maybe this all relates to not being in a "Military Town" or near a "military base", but that shouldn't be the case.
4. For me to figure this out and keep track of everything even though everything is a state of ciaos with the move
5. For joy, peace, and time to be still and meditate this holiday season.
6. To understand that the Lord brought us here to McKinney for a reason and that I need to trust that He will make a way for us medically, socially, emotionally, and financially.

We have more to post, but I want to give this issue it's own light. For all of our dear friends out there in the military, you need to consider where you move. Maybe it is not such a big issue if you retire and get another job as most people do. You can have other insurance and use Tricare as your secondary option. Other's might elect to go straight into the VA system. For us, the VA is an hour away (one way) and it takes a toll on Mike just to go. I can't imagine getting our care there 3-5 days a week.

Praise:

Our house filled with little girls singing "Rudolph the Red Nose Reindeer" while putting up our Christmas Tree

Mike hung a few ornaments on the tree this year.. Last year, he was in the hospital. Thank you God for the small things. It has been two years since we put a tree as a family. We moved to Florida in December 07. Mike was in the hospital in December 08... God proves He is in control in December 09!