Military health care benefits — can they require this?

My fiancée’s mother has recently been diagnosed with breast cancer (Stage III invasive ductal carcinoma, to be exact.) Her health insurance comes through the government due to her ex-husband being retired military and apparently it’s quite good. However, it also has a provision that allows the government to require her to go to a military hospital for treatment if they desire and a facility is within 100 miles.

Well, I’m told they’ve invoked this right, so now my future mother-in-law has to go to a military hospital (which my fiancée says are sub-par) instead of going to one of the best cancer specialists in the area.

Two questions:

a. Is a military hospital a bad place to get treated for this kind of condition?
b. Is there any way to appeal this and get out of it? Anyone have any experience with this?

Military Hospitals vary. Walter Reed has been getting a lot of flack, recently, but the Naval Hospital here in San Diego has a good reputation. She should be consulting with her doctors about the best source of whatever treatment she needs.

But that’s the exact problem… the health insurance policy may prevent her from getting treatment from the best source. We’ve already found that there’s an appeals process, which we’re going to pursue.

The patient care at Walter Reed is quite good. Whatever problems they’ve had aren’t about that.

It does depend on the facility. I had excellent orthopedic care as a kid at Wilford Hall in San Antonio. I would definitely appeal this if she can get demonstrably better care elsewhere, but military medical care doesn’t have to be subpar.

Insurance companies requiring the use of in-network providers (HMOs) for a service to be paid by insurance, or reimbursing out-of-network providers at a lower rate (PPOs) is absolutely normal. She can appeal, but I don’t see where she has particularly clear grounds. Clearer grounds might be if her condition makes it impossible for her to travel to the military hospital. The fact that there are specialists with a stronger reputation available out of network is not very persuasive to insurance companies. If she can afford it, she might want to pay out of pocket for a consult or two with the local specialists to make sure they agree with how her treatment is going. That way she could benefit from their expertise, but have the more affordable providers do the actual treatments.

I’m retired, the system is called Tricare. There are different Tricare coverages based on the beneficiaries status. If your FiL is retired and not yet on SS it’s one coverage. If he’s on SS he must be enrolled in Medicare part “B” and then he is eligible for Tricare for Life.
the 100 mile radius you cite sounds excessive, but it’s not an issue for me so I can’t say for sure.
I’d suggest you visit the Tricare web site and look for answers there. It’s a huge site and takes some patience to find what you’re looking for, but if you persevere you’ll find it.
Some parts of the site require the beneficiary to register, so you may have to do this w/ your FiL.
Alternatively, CONUS is divided into service areas, after you determine your FiL’s service area you can call and, in my experience, they are very helpful.
If I can help more let me know.

Walter Reed Army Hospital has some of the best healthcare there is in the military. The hospital recently passed its recertification at the highest level. The problem is with outpatient quarters on the grounds of the hospital.

Big difference, not that the media would ever care to be accurate about it.

Thank you, Duckster, you were clearer.

A.R. Cane The Tricare is just for active and fully retired military, am I correct?
Also, the Durham Veterans Hospital is, in my opinion one of the finest in the country. Excellent concern and care. And, Duke hospital is right across the street!

That’s good to know.

My fiancée has very bad memories of treatment she and her family have received at military hospitals, so sticking with that just isn’t an option for her. She actually called her dad, who then called the guy in charge of Tricare at a military base, and even he said that they were being unreasonable in claiming right of first refusal. He also gave detailed instructions for an appeal: cite economic hardship, unreliable transportation, and other factors (all of which are 100 percent true). And if the appeal is declined, my mother-in-law-to-be can also change to a different form of Tricare which will allow her to go see whoever she wants, but with more out of pocket costs (which she would get help with from us). So right now, it looks like we’ve found a way for her to get the best treatment available. We even wrote a letter to her congressman, which can prove surprisingly effective.

A.R. Cane The Tricare is just for active and fully retired military, am I correct?

That’s correct, to include their legal depends.