ACCESSING YOUR HEALTH CARE

1

• ACCESSING YOUR HEALTH CARE

December 2007
2
Where do Active Duty Access health care?

• NMCSD
• Military Health Center
• Located in Building 1 1st Floor
• Mon Fri from 0700-1600
• By appointment only call 532-6666
• Branch Clinics

All Active Duty members must be enrolled in
TRICARE Prime this is mandatory and is not
automatic!
3
How do Active Duty Access health care?

• Routine Care Call your Primary Care Manager
  (PCM) for appointment.
• Urgent Care Call your PCM to obtain medical
  advise during normal work hours or call
  1-800-453-0491 after hours.
• Emergent Care
• Call 911
• Go to the closest military or civilian emergency
  room.
• Be sure to give civilian facilities your TRICARE
  information.

4
Title 10 of the United States Code

• Priority of treatment in Military Hospitals and
  clinics under TRICARE.
• Active Duty
• Active Duty family members enrolled in Prime
• Retirees and family members enrolled in Prime
• TRICARE Plus
• Active duty family members not in Prime
• Retirees and family members not in Prime

5
TRICARE OPTIONS FOR YOUR FAMILY

• STANDARD
• EXTRA
• PRIME

Parent Parent-in-laws are not eligible for
TRICARE benefits
6
TRICARE Extra (PPO) Standard

• No enrollment needed
• Offers the highest out-of-pocket cost and more
  paperwork
• Space A is limited in MTF specialty clinics only

7
TRICARE Prime (HMO)

• Offers the lowest out-of-pocket cost and less
  paperwork
• You must enroll into TRICARE Prime.
• 20th of the month rules apply to new enrollees
  unless you are retiring. Members who are retiring
  should enroll within 30 days prior to retirement
  date to prevent break in Prime coverage.
• Enrollees receive all routine care from Primary
  Care Managers and must be referred for any other
  routine or specialty care.
• Any unauthorized care is subject to high
  deductibles and cost-shares also known as the
  Point of Service option.
• (Active duty members are not eligible for Point
  of Service option)

Contact TRICARE for instances when the 20th of
the month does not apply. (i.e. enrolling
newborns, adoptions or portability's)
8
Point Of Service

• Point-of Service (POS).
• Applies to all non-referred, non-emergency
  services received by a PRIME enrollee.
  (Non-Active Duty)
• Deductible 300 per Individual 600 per
  Family
• Cost Share Gov. 50 of CMAC. Beneficiary
  pays balance.

9
Primary Care Clinics

• THREE AT HOSPITAL
• INTERNAL MEDICINE
• PEDIATRICS
• (12/13yrs 21 yrs)
• ADOLESCENT
• (12/13yrs 21 yrs)
• PRIMARY CARE CENTER, NTC
• PRIMARY CARE GROUP, CORONADO
• MIRAMAR FAMILY PRACTICE
• THREE TRICARE OUTPATIENT CLINICS
• CLAIREMONT
• CHULA VISTA
• SANTEE
• CONTACT YOUR LOCAL TRICARE OFFICE TO CHANGE
  PRIMARY CARE CLINIC.

10
How do Family Members Access health care?

• Routine Care Call your Primary Care Manager
  (PCM) for appointment.
• Urgent Care Call your PCM to obtain medical
  advise during normal work hours or call
  1-866-874-9378 after hours.
• Emergent Care
• Call 911
• Go to the closest military or civilian emergency
  room.
• Be sure to give civilian facilities your TRICARE
  information.

11
One-Stop Appointment Center

• [phone] or [phone]
• Services All Primary Care Clinics
• Schedule Acute and Routine Appointments
• Cancel appointments
• Leave messages for Primary Care Manager
• OPEN MON-FRI 0600-2000
• WEEKENDS/HOLIDAYS 0800-1800

12
Access Standards

• Max. wait for Primary Care
• 1 day urgent care
• 1 week for routine visits
• 4 weeks for well care visits
• Max. wait for specialty care
• Generally, no longer than 4 weeks (28
  business days)

13
Phone Numbers

• DEERS
• (Eligibility Issues and address changes)
• 1-800-538-9552
• TRICARE
• National Database www.tricare.osd.mil
• 1-888-TRIWEST (1-888-874-9378)
• www.triwest.com

14
Phone Numbers

• Dental Benefits
• United Concordia
• (active duty families)
• 1-800-866-8499
• www.ucci.com
• Delta Dental
• (retirees)
• 1-888-838-8737
• www.trdp.org
• Enrolling into TRICARE does not enroll members
  into Dental. This must be done separately.

15
Health Benefits Advisors

• Personalized counseling for all beneficiaries on
  all TRICARE Programs.
• NMCSD disengagement counseling
• Determine eligibility for benefits
• Coordinate Issuance of Non Availability
  Statements
• Secretary of the Navy Designee Requests
• Process TRICARE Prime Travel Entitlements for
  patient and non-medical attendants
• The Debt Collection Assistance Officer (DCAO) HBA
  helps beneficiaries understand the TRICARE claims
  process, including information on resolving
  unpaid healthcare claims/medical bills
• And Much MorePlease contact one of your local
  Health Benefits Advisors for assistance.

16
NEED ANSWERS, SERVICE, OPTIONS?

• Medical coverage out of country
• Children loss entitlement because of age
• Incapacitated child
• Getting out of the military
• Other insurance and third party liability
• How to appeal
• Adopting a child
• Second opinions.etc..

17
Health Benefits Advisors

• Naval Medical Center San Diego
• [phone]
• Monday Friday
• 0700 1630
• Building 2 Floor 1st
• No appointment needed
• Branch Medical Clinic North Island
• Bldg 601, Room 139
• [phone]

18
Patient Relations
19
NMCSDs Patient Relations Mission Statement

• The Patient Relations Department is committed to
  delivering proactive based customer service to
  our beneficiaries while providing supportive and
  timely guidance to hospital staff.

20
Contact Patient Relations when

• Compliments or letters of appreciation.
• Resolution can not be met directly with your
  healthcare team or Customer Service
  Representative.
• Translation and communication assistance is
  needed.
• If you feel your concerns are not being
  addressed.
• Inability to get your healthcare needs met.
• Suggestions, recommendations, complaints.

21
Contact Patient Relations via

• Customer Service Representative
• Patient Contact Worksheet
• Internet at http//www-nmcsd.med.navy.mil
• Phone at [phone]/8
• Walk-in to office

22
Why?

• BECAUSE Patients are our focus
• SUCCESS is judged by those we serve
• AND we strive to
• Be the Nations premier Military Medical Center
  providing world-class care any time, anywhere.

23
Patient Relations Contact information

• Naval Medical Center San Diego
• Department of Patient Relations
• Andrea L. Graves, Department Head
• Command Suite
• Building 1, 1st Deck
• [phone] or [phone]
• www.nmcsd.med.navy.mil
• THANK YOU!

24
Questions