Tricare question about specialty dr appts

[letsbeawkward]

I plan on going to the Tricare office on base tomorrow to talk to them about this but I'm curious if anyone else has had this issue.

I saw my PCM last week because I have a very suspicious mole that has changed shape and size withing the past few months. He saw it and said it definitely needs to be looked at by a dermatologist and he thinks it will need to be removed. He warned me that our area only has 2 dermatologists and they are always booked up months in advance. They called to get me an appointment and the first available is December 28.

Has anyone ever been in a situation like this where an appointment is not available within a reasonable amount of time? Does Tricare ever allow you to travel outside your area to see a doctor? There is a major city within a few hours of us which is also my hometown so we go there quite often. It would be nice if I could just get an appt there.

It doesn't help that I am googling pictures of melanoma and they look exactly like what is on me. I am freaking myself out.

[Deleted]

I'm pretty sure if they think you have cancer they will fit you in.

[JakJak]

Jul 24, 2012 20:59:34 GMT -5 killercupcake said:

1: Stop googling.

2: I'm pretty sure that as long as your doctor refers you out to a specific doctor, Tricare will cover it. So if your Dr refers you to a doctor that is in another area, Tricare will authorize the visit.

This. Call around and ask availability. Let them know that it's urgent, and get a referral from your dr.

[letsbeawkward]

Jul 24, 2012 21:08:49 GMT -5 JakJak said:

Jul 24, 2012 20:59:34 GMT -5 killercupcake said:

1: Stop googling.

2: I'm pretty sure that as long as your doctor refers you out to a specific doctor, Tricare will cover it. So if your Dr refers you to a doctor that is in another area, Tricare will authorize the visit.

This. Call around and ask availability. Let them know that it's urgent, and get a referral from your dr.

Thank you ladies. That is what I was hoping for.

LL, my dr obviously didn't look at it and say yep, it's cancer! But he thinks it will need to be removed for testing.

[basilosaurus]

6 months is unacceptable. They will refer you to out of network if in network isn't available. I'm trying to find the specifics on what "available" is. I think no appts in 6 months would count. Have you called tricare directly?

[letsbeawkward]

I am going to speak with them tomorrow Sibil so I will find out for sure.

[amaristella]

I vaguely remember there being a maximum wait time for an appointment with a specialist. I think I have it on one of my referral letters.

Here's what it says on my Tricare North Specialty Referral Instructions sheet:

(The priority of your request is marked as either routine or priority)
Routine (Tricare Prime patients should be seen within 28 days)
Priority (Tricare Prime patients should be seen in 72 hours to 7 days)

Don't know what region you're in, but the number mine says to call for any and all questions in the North region is 1-877-TRICARE (1-877-874-2273) and that's for Health Net Federal Services

[audette]

Jul 24, 2012 21:57:53 GMT -5 amaristella said:

I vaguely remember there being a maximum wait time for an appointment with a specialist. I think I have it on one of my referral letters.

Here's what it says on my Tricare North Specialty Referral Instructions sheet:

(The priority of your request is marked as either routine or priority)
Routine (Tricare Prime patients should be seen within 28 days)
Priority (Tricare Prime patients should be seen in 72 hours to 7 days)

Don't know what region you're in, but the number mine says to call for any and all questions in the North region is 1-877-TRICARE (1-877-874-2273) and that's for Health Net Federal Services

This is good information to know. (obviously, I'd want to confirm for my region - we're not in North)

In the last two years I have twice had to see specialists who were unable to get me an appointment within two months. It was frustrating, to say the least. I'll have to remember this the next time I have to deal with that frustration. Perhaps I would not have ended up with the asshole of an endocrinologist I've got right now...

[krista]

Jul 24, 2012 23:07:42 GMT -5 audette said:

Jul 24, 2012 21:57:53 GMT -5 amaristella said:

I vaguely remember there being a maximum wait time for an appointment with a specialist. I think I have it on one of my referral letters.

Here's what it says on my Tricare North Specialty Referral Instructions sheet:

(The priority of your request is marked as either routine or priority)
Routine (Tricare Prime patients should be seen within 28 days)
Priority (Tricare Prime patients should be seen in 72 hours to 7 days)

Don't know what region you're in, but the number mine says to call for any and all questions in the North region is 1-877-TRICARE (1-877-874-2273) and that's for Health Net Federal Services

This is good information to know. (obviously, I'd want to confirm for my region - we're not in North)

In the last two years I have twice had to see specialists who were unable to get me an appointment within two months. It was frustrating, to say the least. I'll have to remember this the next time I have to deal with that frustration. Perhaps I would not have ended up with the asshole of an endocrinologist I've got right now...

That's not right. The access to care standards state for routine specialty appointments, you should be seen within 30 days and the provider should be within a 60 minute drive. The next time you're offered a routine appt longer than 30 days out, remind them of Tricare's (all regions) access to care standards.

[audette]

Jul 25, 2012 5:26:33 GMT -5 krista said:

Jul 24, 2012 23:07:42 GMT -5 audette said:

This is good information to know. (obviously, I'd want to confirm for my region - we're not in North)

In the last two years I have twice had to see specialists who were unable to get me an appointment within two months. It was frustrating, to say the least. I'll have to remember this the next time I have to deal with that frustration. Perhaps I would not have ended up with the asshole of an endocrinologist I've got right now...

That's not right. The access to care standards state for routine specialty appointments, you should be seen within 30 days and the provider should be within a 60 minute drive. The next time you're offered a routine appt longer than 30 days out, remind them of Tricare's (all regions) access to care standards.

Standard for all regions. Huh. I will be remembering this, thank you! (sadly, one of the specialists was an ObGyn at the base hospital - that was a two month wait, and the other ObGyn's within an hour that accepted Tricare had longer waits... I remember calling around trying to find one...)

We are likely moving OCONUS next year, and we have been told that specialty medical care will be problematic in the area we would be going (as in, we will be 2 hours from most specialty care unless we find a translator). Not sure how that works with the Tricare standard of care, but at least we are being informed ahead of time, and we have the option of the servicemember going alone if that makes us nervous.

DH and I are thinking of starting our family there, and because of my age (and only my age), I'll probably be defaulted to "high risk pregnancy". Should be an experience...

[letsbeawkward]

Just an update, I spoke to Tricare and they told me to pick another Dr that I want to see. Then call them back and let them know and they will review it and either approve or deny my request. She said they try to keep it within 30 miles of where I am but since my options are slim out here it will probably be approved for me to go to the larger city about 3 hrs from here.

Eta: I found a dr who can get me in next week. Called tricare and they changed my referral right over the phone. No problem.

[letsbeawkward]

And thank you everyone for the info!