Posted on: Monday, June 13, 2005

Many doctors refuse military insurance

By Chris Vaughn
Knight Ridder News Service

FORT WORTH, Texas — Melissa Noriega got sick, very sick, and couldn't go to her doctor.

She had the wrong insurance. It was the military's insurance.

"I called a bunch of doctors, and not one of them took it," said Noriega, a Houston resident whose husband, Rick, was mobilized by the Texas National Guard and sent to Afghanistan last year.

"I went three weeks trying to figure out how to get an antibiotic-resistant infection treated," Noriega said. "Finally my husband's cousin, who is a doctor, treated me for free."

Noriega's experience has highlighted a problem in the call-up of thousands of reservists and members of the National Guard outside dense military areas — access to healthcare.

Doctors are not lining up to accept Tricare, a government insurance program that in some cases pays doctors less than Medicare and Medicaid and has a reputation for slow payments.

"We stopped taking it three or four years ago," said Susan Blue, a neurologist and president of the Tarrant County Medical Society in Fort Worth. "Reimbursement rates are not high these days with anyone, but the military was the first one to go to a point that it wasn't feasible financially to accept it anymore."

Tricare is the $18 billion health plan for 9.1 million active-duty military members, their families and military retirees under 65.

Finding providers who accept Tricare in an area with an active-duty installation isn't difficult, and active-duty military members can always be seen by military doctors on base.

But the family of a mobilized reservist from, say, Houston or Texarkana, suddenly thrown from private insurance into the military plan, isn't always so fortunate.

"It hasn't been obvious as a problem," said Noriega, who served her husband's term as a state representative this spring. "When a spouse has their own insurance, they can move everybody in the family onto theirs. But folks that don't have a job and they've got three children are just stuck."

"You have some very narrow choices as to who will accept Tricare," said Ray Lindner, executive director of the National Guard Association of Texas. "When it comes to specialists, your choices narrow even more significantly."

Although there is no evidence that families are going without healthcare or a provider, a reservist's spouse and children might have to switch doctors while they're in the military system.

That hardly seems fair, military groups contend, when a family is already dealing with the absence of a spouse for up to 12 months.

"It doesn't matter if you can find a doctor, because when it's your doctor that doesn't take it, it's an individual crisis," said Sue Schwartz, a deputy director in the Military Officers Association of America and the wife of a Marine.

Humana Military Healthcare Services, which administers the Tricare contract in the South, has added 750 more family doctors, 1,300 specialists and 36 hospitals to its list in Texas in the past six months, said Dick Brown, chief spokesman for Humana.

"We have a really good network compared to what was in place in November 2004," when Humana took over the contract, Brown said. "Our network development efforts are continuing now."

Brown also said that 99 percent of medical claims are processed within 30 days of receipt, which exceeds the Pentagon's expectations.

U.S. Rep. Joe Schwarz, a Michigan Republican and physician, recently issued a call for doctors nationwide to accept Tricare as "a patriotic duty."

But it's hard for physicians to get past the reimbursement rates, which are tied to Medicare's rates, with a 5 percent reduction anticipated in January.

Dr. Stephen Brotherton, a past president of the Tarrant County Medical Society and an orthopedic surgeon, said his father, a World War II veteran, gave him grief for not accepting Tricare.

"Any of us would love to serve our servicemen, but what they're paying is well below what we have as a break-even point," he said. "It would be better for me to actually see them for no charge and not try to participate in the program."

The Enlisted Association of the National Guard would like Congress to make the healthcare plan for federal employees available to military families.

"Then you don't run into the problem of finding a Tricare provider," said Mike Cline, the organization's executive director. "We don't want it to replace Tricare, but we would like to see it as an option for people."

The Military Officers Association of America is lobbying Congress to allow the Defense Department to offer a choice to reservists: join Tricare or get a lump-sum payment to pay for private insurance.