Outside medical treatment

[ProudUSNAParent20]

Do any current mids know the protocol for receiving outside medical treatment (Eg going to your private doctor over winter leave)? How hard is it to do? Can’t really find anything on the internet regarding using outside medical treatment of any sort.

Thanks in advance.

 

[Devil Doc]

It's as easy as it was prior to starting USNA. Who pays for it is the question.

 

[Capt MJ]

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

Here is some information to start. I am not a current mid, of course, but this issue comes up often enough with regard to non-TRICARE health care. For general readership, TRICARE is the military healthcare system, which all midshipmen are enrolled in.

There have been threads on this in various forums (search on “TRICARE,” “civilian health insurance,” etc.), but I haven’t seen one recently.

Your mid, as an adult on active duty, is best positioned to ask the question of Brigade Medical to find out current policy and how it applies to him or her and any civilian healthcare, and what he or she may or may not do.

I believe parents are encouraged to keep them in their family plan in case of unplanned departure from USNA.

https://www.usna.edu/Commandant/Dir...NST-5400.6T_MIDSHIPMEN-REGULATIONS-MANUAL.pdf

MidRegs, section 9. It’s pretty much assumed midshipmen, similar to other AD members, get their care through TRICARE.

Specialty care is obtained at Walter Reed National Military Medical Center, a teaching hospital with excellent staff. My derm doc (a USNA grad) had gotten his Mohs surgeon skills from a fellowship assignment at Johns Hopkins.

I can’t find the reference that I seem to remember that either prohibits or discourages use of civilian healthcare providers for routine care. One of the concerns is the midshipman not having a complete military medical record, and his TRICARE health care team being unaware of outside care, treated conditions, etc. Another concern is that an external provider may unwittingly prescribe something or do something that can impact a mid’s commissionability.

If it’s something your mid wants to do, then your mid must determine Navy policy as it applies to his or her case.

 

[Old Navy BGO]

Your mid, as an adult on active duty, is best positioned to ask the question of Brigade Medical to find out current policy and how it applies to him or her and any civilian healthcare, and what he or she may or may not do.

^ This ... while I am sure OP is well meaning, and wants to take care of his /her "child", they are in the military healthcare system now. We used to joke that the Navy owns your body, and there is a bit of truth to that. The issue goes beyond "who pays", going outside the system (without proper reporting and approvals) could violate Navy Regs and/or affect medical qualification for Commissioning.

Of course, I don't want to discourage anyone from seeking emergency medical treatment or even acute care while home on leave, but if it is routine or preventative maintenance, DS/DD should talk to Brigade Medical and get the rules directly.

 

[Devil Doc]

I guessed that proud parent's Mid is in the class of 20 due to the screen name and probably knew how to click around for instructions. And of course midshipmen are constrained more than other military members and there's probably a directive somewhere that forbids being seen outside the network. But, people get seen often by non-military providers. If it is of a routine nature there isn't much difference than buying OTC meds and using them. I know it's hard to believe but I've known pilots who self-diagnose and medicate so as to avoid a down chit. I've had Sailors and Marines and Navy officers bring back records and scripts from off base to be entered in their records. Sometimes they just wanted to talk about it with no record entry like that time in Thailand.

Anyway, I know I should have said no, go to the clinic or just not have not responded. The fact remains, if a member regardless of status wants to be seen by a civilian, whose to stop them? The morals and legality is a different question which I didn't see in the OP. Routine, non-emergent care not previously authorized will not be paid for by Tricare which is why I made the payment comment.

 

[emwvmi01]

There are many issues with TRICARE but one thing I found they do pretty well is provide assistance when you are on leave/in transit. You can call the toll free Tricare line and they will let you know what the available options are for hospitals/urgent care and providers. Your mid should have that info and if not it isn't hard to access.

 

[Capt MJ]

Returning to the OP’s OQ, I believe it’s not an issue of payment. It’s pretty clear TRICARE normally won’t pay for routine care outside the system, and the procedure is well-established for a mid to get emergency or urgent care from a civilian provider while traveling on leave or duty reasons, using TRICARE as the insurance.

I think the question is seeing a civilian provider at home for presumably non-urgent reasons, with no intent to use TRICARE as the insurer, for whatever reasons the mid wants to see someone outside the military healthcare system.

It comes down to the mid taking responsibility for determining what policies apply, or, proceeding without that knowledge, and taking any risks or consequences that might arise from his or her military healthcare provider not having visibility of another provider’s actions.

 

[Old Navy BGO]

I know it's hard to believe but I've known pilots who self-diagnose and medicate so as to avoid a down chit.

No, tell me that is not so Doc ! It took me years to overcome the mindset that Doctors were something to avoid at all costs.
(And we even had a pretty cool flight surgeon). I have gotten to the age where I almost believe that Doctors actually help you, and even volunteer information about my health now.

 

[Devil Doc]

I know it's hard to believe but I've known pilots who self-diagnose and medicate so as to avoid a down chit.

No, tell me that is not so Doc ! It took me years to overcome the mindset that Doctors were something to avoid at all costs.
(And we even had a pretty cool flight surgeon). I have gotten to the age where I almost believe that Doctors actually help you, and even volunteer information about my health now.

Times have changed and patients have more say in their care and treatment. I was LCPO of clinical services, aviation medicine, and the APTU at Cecil Field in the middle 90s. I learned and even contributed to the knowledge of several flight surgeons in my time there. Most were very cool, almost Maverick like, and medically proficient. FYI for those who might not know, IDCs in most primary care environments see the same patients and have the same privileges as physicians. When I joined this forum I stated I could comment on operational and deck plate situations. If I offer bad gouge hopefully someone will correct it. If a military member chooses to see a civilian Doc though, it's their choice and payment is actually the issue.

 

[GoCubbies]

I know it's hard to believe but I've known pilots who self-diagnose and medicate so as to avoid a down chit.

No, tell me that is not so Doc ! It took me years to overcome the mindset that Doctors were something to avoid at all costs.
(And we even had a pretty cool flight surgeon). I have gotten to the age where I almost believe that Doctors actually help you, and even volunteer information about my health now.

Flight surgeons treating aircrew is the same as pediatricians treating kids. You still have to talk to their significant other (aircrew... the spouse; kids... the parents) to get the story on what's really going on.

 

[GoCubbies]

Do any current mids know the protocol for receiving outside medical treatment (Eg going to your private doctor over winter leave)? How hard is it to do? Can’t really find anything on the internet regarding using outside medical treatment of any sort.

Thanks in advance.

Your mid is assigned as Tricare Prime to NHC Annapolis. That means the PCM is there and treatment has to go through that PCM.

If on leave and an issue where life, limb, and eyesight is at risk, then go to the ER. No pre-authorization is required.

If a minor medical issue (e.g. cold symptoms from playing in the snow, back pain from putting up drywall for mommy and daddy, etc...) comes up, then an urgent care center (UCC) is more appropriate. In that case, you must call the Tricare Nurse Advice line. The nurse will ask a bunch of questions and decide if further care is needed. If further care is needed, then nurse will give an authorization to be seen at an UCC. As an aside, family members on Tricare Prime do not need prior authorization to get seen at an UCC. They just go and get seen. It's pretty convenient. Active duty personnel must have prior authorization to get seen at an UCC.

If, for example, your mid wants to be seen on leave by an orthopedic surgeon (maybe for knee or shoulder pain), then that requires a bit more paperwork. First of all, that orthopedic surgeon must be in the Tricare network. Next, the PCM at NHC-Annapolis must submit a referral for the mid to be seen by that orthopedic surgeon. Ideally, the referral (and approval) is done before seeing the specialist. The PCM must submit a good clinical reason why the mid must be seen by an orthopedic surgeon while on leave near the home instead of the orthopedic surgeon at NHC-Annapolis. If there is no good clinical indication (convenience isn't a good reason) that the mid must be seen by the orthopedic surgeon near the home while on leave, then the authorization will most likely not be approved.

If you want your mid to see a specialist while on leave and don't want to involve Tricare, then by all means have him/her go see the specialist. You'll pay for the visit but your mid will get to see a specialist while on leave. One thing I recommend is your mid get a copy of the notes from the specialist. When he/she returns to the Academy, the notes can scanned and uploaded into the electronic medical records for record keeping.

 

[Capt MJ]

Best sum-up above!
It’s always a good practice to bring back any records from providers outside TRICARE and get that into the military medical record.

 

[Devil Doc]

I know it's hard to believe but I've known pilots who self-diagnose and medicate so as to avoid a down chit.

No, tell me that is not so Doc ! It took me years to overcome the mindset that Doctors were something to avoid at all costs.
(And we even had a pretty cool flight surgeon). I have gotten to the age where I almost believe that Doctors actually help you, and even volunteer information about my health now.

Flight surgeons treating aircrew is the same as pediatricians treating kids. You still have to talk to their significant other (aircrew... the spouse; kids... the parents) to get the story on what's really going on.

Flight surgeons aren't the only providers who care for aircrews. As an IDC I was the senior Doc on ships with helo detachments and at Cecil Field where the flight surgeons were supposed to be at the clinic and also supposed to be at the squadron, at the same time. Somebody has to see them.

 

[usna1985]

Your mid will be told the "rules" on getting outside medical care. In our day, if you were on leave you were supposed to go to a military facility for needed medicare care, if one was readily available. If not, you were supposed to call USNA medical for "authorization" to visit a civilian provider. Obviously, in an emergency, you go to the ER but notify USNA as soon as possible.

In my day, you were no longer supposed to visit your civilian doctor for "routine" stuff because you were now a military member and should use that system. However this is many years later and things may well have changed. As noted, your mid will be told prior to his/her first leave.

 

[Cerberi]

The military provides socialized medicine which is generally good. However, my Mid is also covered by my insurance plan and I wouldn’t hesitate for a minute encouraging her to get a non military medical opinion.

As for me - the quality of care I received as a cadet and on active duty was not good and I am reminded of it daily 30 years later.

Had a classmate nearly die from a ruptured appendix and being turned away from the clinic multiple times - they suggested she might be pregnant even though she was adamant that wasn’t even possible.

Just was reminded of a Mid’s Plebe Summer where he was throwing up blood and was essentially told it was the Plebe Hack - ultimately it required an ambulance ride to Bethesda a few days later and a very long recovery time.

 

[eseymour]

Totally agree with you! I would also prefer to consult a doctor outside the military units. But again, all cases are strictly individual. But with serious health problems, I would not neglect the possibility of accessing several doctors at the same time.

 

[DKTKT]

Anyone have an insights on how outside care issues might apply to dental? DS has finished ortho treatment, but has permanent retainer and spacers where he has missing teeth (due to my bad genes, alas!) He has been advised by periodontist to wait until his jaw bone is fully matured at ~21 years old to get dental implants. All of this info was supplied to DoDMERB, and he was medically qualified. But I just don't know what that means USN expects to happen here. We are happy to pay for DS to get the implants when he is on leave, but will they let us? The thought of USN wanting a cheaper solution like bridges after all we have invested in that smile is pretty painful.

 

[kp2001]

Anyone have an insights on how outside care issues might apply to dental? DS has finished ortho treatment, but has permanent retainer and spacers where he has missing teeth (due to my bad genes, alas!) He has been advised by periodontist to wait until his jaw bone is fully matured at ~21 years old to get dental implants. All of this info was supplied to DoDMERB, and he was medically qualified. But I just don't know what that means USN expects to happen here. We are happy to pay for DS to get the implants when he is on leave, but will they let us? The thought of USN wanting a cheaper solution like bridges after all we have invested in that smile is pretty painful.

Surgeons like to operate, if implants are what are needed then that’s what they will likely do. The Navy has specialists in pretty much all areas of dental. At USNA they’ll be sent to Walter Reed for that level of care, if they end up at a smaller base then it’s possible they may refer them to town.

 

[emwvmi01]

Anyone have an insights on how outside care issues might apply to dental? DS has finished ortho treatment, but has permanent retainer and spacers where he has missing teeth (due to my bad genes, alas!) He has been advised by periodontist to wait until his jaw bone is fully matured at ~21 years old to get dental implants. All of this info was supplied to DoDMERB, and he was medically qualified. But I just don't know what that means USN expects to happen here. We are happy to pay for DS to get the implants when he is on leave, but will they let us? The thought of USN wanting a cheaper solution like bridges after all we have invested in that smile is pretty painful.

This is just a guess but I think USNA/Navy medicine will probably assess him and may end up offering to have the implants done and paid for by Tricare. I know based on personal experience that DOD performs implants and it is based on the thought that it contributes to your overall medical health and readiness. I had it done through a joint DOD hospital. So definitely recommend waiting until he is at USNA and let the docs there evaluate and then follow their guidance.