Insurance Question

Discussion in 'Naval Academy - USNA' started by 0630RestrictionMuster, May 2, 2017.

  1. 0630RestrictionMuster

    0630RestrictionMuster New Member

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    Current Mid at the Academy-

    I need to have my nose repaired from an injury last fall. It's both cosmetic and functional and it's something I don't want to take to Walter-Reed. Is it possible to use my parent's insurance to be referred out to a civilian specialist? BMU doesn't have the best track record with surgeries and follow ups so I'd like to do it on leave this summer. Additionally I have Tricare Prime under my parents. Thank you for everything.
     
  2. Capt MJ

    Capt MJ 10-Year Member

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    Now that you are on active duty yourself, you are your own sponsor on TRICARE Prime for active duty - that may have an impact on you trying to still get care as a dependent on a parent's TRICARE Prime - your Prime "policy number" is your SSN, which is how you are reflected in the system, ditto your parent's SSN. I do not know how that would play out.

    I would encourage you to go through the process of getting a referral to WRNMMC and getting the injury evaluated, and a treatment plan developed. Since it is apparently not urgent, you could explore whether they would refer it to a provider near your home during the leave period., under YOUR status in TRICARE Prime as an adult on AD. There is a TRICARE service office at the hospital, and I think a small satellite at Hospital Point.

    I understand BMU gets a bad rap, sometimes deservedly. I have had excellent experience with WRNMMC providers, as it is the nation's flagship military teaching hospital.

    Military hospitals do refer out to civilian providers when capacity is an issue.

    These are thoughts based on years as a military medical care beneficiary, and watching dozens of our sponsor mids get various things done. Not an official answer!

    Please see the link below for some more info.

    https://tricare.mil/LifeEvents/College/ServiceAcademy


    Edit: Your focus in discussions should be on the functional/medical aspects of your nose injury, not the cosmetic. Military medicine has its priorities.
    I had a broken nose injury before I entered the service, leaving me with a nice bump. I had an additional line of duty injury to my nose (thrown violently around in an LCM when hit crosswise by a large wave) causing injury to the septum. The nice ENT surgeon at the military hospital called in the plastics senior resident to achieve the best result. I was very happy with the result. I was good practice for the plastics doc.
     
    Last edited: May 2, 2017
  3. Old Navy BGO

    Old Navy BGO 5-Year Member

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    You may be playing with fire asking for advice here. I wouldn't recommend doing anything with a private physician without concurrence of your chain of command and/or Navy medical. I seem to recall some admonition that the Navy owns your body now. If you do it secretly, and have complications, you could have trouble.

    That being said, if you went to your chain of command or Navy Medical, and made the pitch that you wanted to get it done at home on leave,and could get covered under Tricare, I would expect (or hope) that Navy would support it.
     
  4. Sydney C.

    Sydney C. 5-Year Member

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    It's complicated as the Capt. has alluded to and we recently went through something similar so hopefully our experience can help a bit.
    First, and as the Capt. has mentioned, you need to go through the process with BMU as they need to monitor your medcial situation. Following that, it's more than likely they'll refer you to ENT for an evaluation of your condition and a treatment plan. If you proceed with having this done on your own without their oversight and something, anything, should happen in terms of complication, infection, etc. and they didn't know about it...you're in some trouble.

    You say that you need the repair so I'll assume that a medcial professional (perhaps a physician that you saw at home) has determined that and you've got some medcial records to support that. If so, they'll look at that and compare notes. There a lot of things that WRNMMC does well with great outcomes and some perhaps not as expert at but that goes for most hospital systems. It is possible that they may allow you to have this done elsewhere depending on the situation and if they feel it's something better done elsewhere if they deem it appropriate. It is a case by case evaluation.(It does happen, but it must be reviewed and they have to grant the permission)

    Finally, there is the insurance issue which would need to be resolved.
    I wish you the best in getting this resolved.
     
  5. vadad23

    vadad23 Member

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    PM me. You may need to get 5 or 10 posts before able to do so. Can give you some insight for both BMU and the civilians side to get this taken car of.
     
  6. USMAROTCFamily

    USMAROTCFamily 5-Year Member

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    We have TriCare Prime and I can tell you that our cadet is no longer covered under our "policy". As as soon as he got into system at West Point, he was pulled out as a covered dependent. Definitely, work this out through the Yard.
     
  7. ktnatalk

    ktnatalk Sailor. Shipmate. Parent.

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    Tricare is based on DEERS (Defense Enrollment Eligibility Reporting System) to decide if a person is covered. Once enrolled in a SA you are on active duty and should have became your own "sponsor ". If some how you are still shown under your parents in DEERS that needs to be corrected. Last thing you want is to have the system catch up and you owe the charges.

    If a mid disenrolled from a SA he/she can be added back under his/her parents.
     
  8. kp2001

    kp2001 10-Year Member

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    Here is what's going to happen when you try to check in or make a routine appointment at another facility when back home under your parents tricare prime: the clerk will ask you for the sponsors social, you'll give them your mom or dads social (whichever one it was that served) and then they will ask for the patients date of birth. You'll give them your date of birth and one of two things will happen: 1) they will say nobody is enrolled with that DOB (because your info has now been switched over to your own account with a 20 prefix....(20 means sponsor, 30 is spouse, 01/02/03/etc are children) or 2) they will see your info but it will now show as a secondary alias with a 20 account also attached.

    Either way they likely won't be able to book an actual appointment because your enrollment has shifted to a different facility thereby making it nearly impossible to actually make an appointment within the computer system. You would have to shift your enrollment back to that facility, and then back again after returning to school, at which point they would be able to make you an appointment with your new PCM as required to start a referral to an ENT specialist. If they have ENT there then you would be assigned to that location, if not then it is possible you could be referred into town. Then you'd be seen by the ENT doc and by then it would be time to return to school.

    The bottom line is: no, you don't really have the option you propose.
     
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  9. Capt MJ

    Capt MJ 10-Year Member

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    Always good to see Doc kp weigh in with solid info.