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  • IC and the Military Healthcare System

    IC And The Military Healthcare System
    One Patient’s Experience

    By April Chen - Beavercreek, Ohio

    I am a 29 year old former teacher with IC and am the proud wife of three years to an Air Force Captain. He is currently stationed at Wright-Patterson Air Force Base in Dayton, Ohio. My experience with the military health system has been both positive and negative. I would take a moment to share some strategies that could help other IC patients working with military health care.

    Health Insurance:

    The military health insurance program is called TRICARE. Throughout the nation, there are different TRICARE regions. We, for example, are in the TRICARE North region, (known as Health Net Federal Services). Our region includes Ohio and its surrounding states.

    Within TRICARE, there are three separate programs available.

    TRICARE Prime is the insurance that most dependents opt to receive. It is referral and authorization based and operates like many health maintenance organizations (HMO’s). You have a primary care manager (PCM) who handles most of your care and makes any necessary referrals to specialists. The advantage of this plan is that all of your care is covered and there are no copayments required as long as you follow their proper procedures about using referrals. It can be tedious but is well worth the effort. I’ve been doing it so long that I’m very accustomed to the procedures.

    TRI-CARE Standard is a fee-for-service program that allows you more choice in who you see but also has higher out of pocket costs. Copayments and yearly deductibles are required. Rather than having a PCM, you can often choose which medical care providers that you work with but that depends entirely on if those doctors accept TRICARE insurance.

    TRICARE Prime Remote is a program for families that are assigned to overseas military bases. TRICARE Reserve Select are for qualified reservists.

    My husband and I chose TRICARE Prime for our coverage because we felt that we could work with a central provider to get the specialized care that I, in particular, needed. Like many IC patients, I have a very complicated health history. Luckily, we’re at a very sophisticated military base which offers a wide variety of care and expertise.

    Prescription Coverage

    Like other health insurance programs, prescriptions may or may not be covered. Luckily, there are two formularies that may cover your medication, the TRICARE formulary and the base formulary. If a medication is covered by the base formulary, then you can receive for free. If it’s not covered by the base but is covered by TRICARE, they will refer you to a civilian pharmacy (i.e. Walgreens) for the medication. You can also use a mail order pharmacy, Express Scripts. Both of these programs tend to have very low co-payments.

    You may also have to use a medical necessity form if your physician feels that a specific medication must be used rather than a medication on the formulary. For example, I am currently using Ambien CR to help improve my sleep quality. The formulary suggested that we use Lunesta but Lunesta gave me severe rebound headaches. In order to get Ambien CR covered, my doctor simply had to fill out the form. It was no problem at all, once I explained the ramifications of taking Lunesta or other alternatives.

    Outside Referrals May Be Needed

    My bladder symptoms began in 2004, two years before I married my husband. Like many other patients, I thought that I was struggling repeated bladder infections. It wasn’t until I started participating in the military health care system that I was finally diagnosed properly. However, getting there was a journey.

    At the time, we were stationed at Keesler Air Force Base in Biloxi, MS. When I first sought care at the base, they had been damaged extensively by Hurricane Katrina thus I was sent to an outside internal medicine physician. She was a wonderful physician who truly listened to me when I explained my symptoms. She did not, however, suggest “interstitial cystitis” as the cause. She thought that I could have overactive bladder. I was pretty tired of my symptoms and desperate for answers. I got online and just googled “pelvic pain bladder urgency frequency” and found the Interstitial Cystitis Network. I felt like this was the answer. My symptoms were identical to those with IC.

    I went back to the internal medicine specialist and said I thought that I had IC. She thought that it was possible and referred me to a urologist for a diagnostic workup. The urologist was a hard sell. He mostly worked with men with prostatitis rather than women with IC. It took about a month of seeing him before he would perform a hydrodistention with cystoscopy (under anesthesia). In January 2007, I was diagnosed with IC.

    I tried a number of therapies (such as Elmiron by mouth, and Flomax) with no success. Because of my repeated visits to the doctor complaining of pain, I was eventually referred to a pain management specialist who had no clue what IC was. His answer for me was to use four or five narcotic medications which I used for about a year before I was introduced to the idea of using heparin and lidocaine bladder instillations (aka rescue instillations). I was eventually taught to do these at home.

    We relocated to Wright-Patterson Air Force Base in December 2007 and that move was a life changing moment in my life as far as my IC is concerned. Given my medical history and diagnosis of IC, I was blessed to be referred to see Dr. Raymond Rackley at the Cleveland Clinic. He is considered one of the best urologists in the country for the treatment of women’s voiding disorders. Luckily, my TRICARE coverage paid for it all because, of course, we went through the proper channels. Like any newly transferred family, we went to the urologist on base first. He quickly said that my case was too complex and referred me immediately.

    Specialty Care

    In the military, referrals made to outside providers are called specialty care. And, at Dr. Rackley’s clinic, I have truly received compassionate and comprehensive care. I am now much more able to control and manage symptoms using the tips and strategies provided by Dr. Rackley. For example, I did a nine month therapy period of Cytotec (Misoprostol), Heparin and Lidocaine instillation therapies. I can’t say it was the easiest thing to do because it comes with several side effects. I probably would not do this therapy again. What I do now is much less abrasive and much more soothing to my bladder. I do instillations of Elmiron, Heparin and Lidocaine three to four times daily into my bladder via intermittent catheterization.

    One of the things that I really like about Dr. Rackley’s clinic is the “group shared appointments.” It might sound invasive to your private information but it is one of the most educational ways to learn about managing your interstitial cystitis. Usually, there are several other patients included and you spend an hour or more with Dr. Rackley and his staff. They give a presentation and then take questions. Dr. Rackley’s nurse practitioner Maria has been my IC angel. She, and his assistant Sally, have been wonderful intermediaries between Dr. Rackley, myself and the military health care system.

    Persistence and Education Pays Off

    In the military system, it can often be overwhelming to be confronted with this complex and procedure driven system. You have to be persistent and vigilant when seeking health care. And, of course, you have to pay attention to the fine print and details. I encourage anyone with IC working in the military system to ask questions of everyone. And, if you don’t get an answer, keep asking and perhaps consult your on base “Patient Advocate.” Cindy, the Patient Advocate at Wright-Patterson, has been instrumental in facilitating communication between me, my providers and getting the necessary medications and care that chronic IC requires.

    Gratitudes

    I would like to take this opportunity to say “Thank You” to several individuals who have helped me in my journey with IC. Dr. Rackley and his team have been superb. The urology clinic at Wright-Patterson has been very helpful in responding to my emergencies. Unlike other specialists, they have no problem contacting Dr. Rackley’s office if they need additional information. The Patient Advocate at Wright Patterson, Cindy, deserves huge accolades for her care and assistance.

    Last but certainly not least, my husband Aaron is the love of my life. Even before we were married and I was struggling with IC, he was always there for me. He was even ever-present when I was struggling to learn how to self-catheterize. To Aaron, I want to say that I love you, all the world, to the moon and back, and with every fiber of my being. There are not enough words to express my gratitude for your constant support, love and understanding.

    I am on the ICN frequently and available by email at [email protected].
    Would you like to talk with someone about your IC struggles? The ICN now offers personal coaching sessions that include myself, Julie Beyer RD on the diet and Dr. Heather Howard on Sexuality. http://www.icnsales.com/icn-personal-coaching/

    Looking for books, magazines & reports on IC? Please visit the ICN Shop at: http://www.icnsales.com: Your ICN subscription & purchases in our shop support these message boards, chats and special events. BECOME AN ICN ANGEL TODAY!

    Please remember that the information on the ICN is provided with the understanding that ICN, its founder, staff, volunteers, and participants are not engaged in rendering medical or professional medical services. We cannot and do not give medical advice. Only your personal physician can do this for you.







  • #2
    April,
    Thanks for this info. My husband is also in the military and will have 20 years in this year. He was going to retire (20 was enough for me), but now we really need the healthcare benefits (since I had a hysterectomy/infection while stationed in MI which led to IC). I wanted to add that my husband told me that they will soon be eliminating Tricare Prime. We have always chosen Tricare Standard and I'm glad we did. We have hardly ever been stationed near a military base. In addition, I don't have to get referals to see specialists. We will once again be moving back to Virginia this summer. Although, I'm not sure how long we will be there. This is a 4 year assignment, but if my husband makes 06 we will have to move again in 2 years. It makes finding good IC doctors difficult and maintaining consistant treatment difficult because we are always moving. I just found a pain management place here and now I am calling ahead to find urologists etc in Virginia. The good thing about Virginia is that there are many military people stationed there, so most offices understand Tricare, (how it works) and most of the doctors take it. My husband and I also bought a supplement to Tricare that covers what Tricare doesn't cover. I have been really happy with it. If Tricare pays on a claim it will pay the rest, even if Tricare only pays $1. All Tricare has to pay is something and our supplement will pick up the rest. We don't have any co-pays. We do have a deductible that is very reasonable. The supplement has been well worth the small amount we paid for it. Tricare has greatly improved since we first got in the military, it was called "Champus" then and we had a terrible time getting them to pay anything. Now, however, it is so much better. From one military spouse to another, thanks for the info and good luck on your next move (they come so fast now). Oh, I also wanted to add that I'm also a former teacher. We have many things in common.
    Last edited by Snowden1; 05-07-2010, 09:40 PM.
    Teresa

    We are not HUMAN BEINGS going through a temporary SPIRITUAL EXPERIENCE. We are SPIRITUAL BEINGS going through a temporary HUMAN EXPERIENCE....so that we may become more SPIRITUAL.

    Comment


    • #3
      My husband was in the Navy for 30 years and is retired and over 65 years old. We have TRICARE FOR LIFE,which is great.

      We have to pay Part B of the Medicare and then Tricare For Life kicks in and there are no co payments. We do NOT need a referral for anything and get our prescriptions free at the Naval Hospital on Camp Legeune,NC if it is available. If we have to go to an out side pharmacy we have a co pay of $3 for Generic,$9 for name brands,$22 for certain medicines.
      My Elmiron costs $9 for 30 day supply. My husband has cancer and has had 2 surgeries,radiation and chemo that he is not done with yet.Once a month he has to have a drug Neulasta in shot form and the cost of it is over $3900.00
      He pays $22.00 for it.
      We have not had to pay for any treatments,Dr. visits,tests,and will not have to.
      Free healthcare for life is a wonderful benefit for retirees,and they earned it.
      I wish everyone had such good coverage. It's something we don't have to worry about.

      Comment


      • #4
        Hi nottoc4
        Oh, my mom and step-father now have TRICARE FOR LIFE. My step-father is retired from the Army after 30 years, and your right, after all of that they deserve it. I am so sorry to hear that your husband has cancer. I am glad though that you get your meds so easily and that they are inexpensive. You are in NC? Just wondering how far that base is away from Chesapeake, VA? I am going to see Dr. Evans in NC in July and wonder if that base would be on our way? Thank you for all the information. It is good to now that we will have this when we retire (if the government health care stays at is now). I know that I have already seen more doctors in the last year and taken more meds than I ever have in my life. At least I feel better knowing that as of now we won't go broke with healthcare costs. I used to be a teacher and we really miss that extra income that I used to make. I don't know that I will ever be able to do that again in the shape I'm in now. I pray that your husband and you get well.
        Teresa

        We are not HUMAN BEINGS going through a temporary SPIRITUAL EXPERIENCE. We are SPIRITUAL BEINGS going through a temporary HUMAN EXPERIENCE....so that we may become more SPIRITUAL.

        Comment


        • #5
          I think Dr. Evans is near Greensboro and High Point on I 40 West from here.
          If you come North on I7 t0 get to I 40W you will pass through Jacksonville and Camp Lejeune.

          Comment


          • #6
            Hi,
            Thank you, very much. I ask my husband about it and he is familiar with that area. I am not at all. Hoping Dr. Evans can help me, though. How do you like NC? Have you lived there long?
            Teresa

            We are not HUMAN BEINGS going through a temporary SPIRITUAL EXPERIENCE. We are SPIRITUAL BEINGS going through a temporary HUMAN EXPERIENCE....so that we may become more SPIRITUAL.

            Comment


            • #7
              I've lived here since 1985 and I love it here. I was born and raised in Pittsburgh Pa and left there in 1978 for job reasons .

              Comment


              • #8
                I was in the Navy for 6 1/2 years. I was about two months from my seperation date when the whole IC thing started. The docs kept giving me the run-around telling me it was repeated UTIs, yeast infection, and even herpes. I really think that because I was so close to my seperation date that they just basically said "sorry, we can't help you". I am glad that the rest of you have had better success that me.

                Comment


                • #9
                  Tricare has been so good to my husband and I with all of his medical bills. I don't know what we're going to do without it.

                  North Carolina is a nice place to live. The hubs & I plan on staying right where we're at. We're close enough to the base that we can utilitize the PX and commissary if we'd like, yet we're far enough away that we aren't surrounded by Marines (unless the hubs has his friends over).

                  Life isn't about waiting for the storm to pass -
                  it's about learning to dance in the rain.


                  ♥♥♥♥♥

                  ♥♥♥♥♥

                  Comment


                  • #10
                    hi!

                    asdasd
                    Last edited by SemperFiBabe; 12-27-2010, 11:42 AM.

                    Comment


                    • #11
                      My husband is getting kicked out of the USMC because of IC so you are lucky to be able to stay in SemperFi. They began his discharge paperwork as soon as he got a diagnosis because IC is a medical disqualifier.

                      Life isn't about waiting for the storm to pass -
                      it's about learning to dance in the rain.


                      ♥♥♥♥♥

                      ♥♥♥♥♥

                      Comment


                      • #12
                        Insurance

                        I am so thankfull to have insurance, but its so sad that so many people suffer or die because they don't have insurance. I love the U.S.A. I live in Alabama and have IC but the health care system for the poor is a disgrace.
                        A friend of mine died a long time ago of an anursym but he did not have insurance they would not see him , you know how you have to pay up front or wont be seen.
                        <center>
                        <a href="http://s1086.photobucket.com/albums/j441/linda5552/?action=view&amp;current=Picture005.jpg" target="_blank"><img src="http://i1086.photobucket.com/albums/j441/linda5552/th_Picture005.jpg" border="0" alt="Photobucket" ></a>
                        </center>

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                        • #13
                          Babygirl, I was in the Navy too....they told me i had no rights after separation...they are WRONG!!!! I am now a disabled Vet not ic related...they take care of my ic....
                          if you have proof that you were having symptoms when you were active the HAVE to take care of you and they HAVE to pay you for it monthly. Get a copy of your records, and take them to your local DAV. Have them put in for disabilitiy....it took me 4 years to get them to admit to my service connected injuries (knee and back). They finally did and i got back pay from when the date i put my claim in. Be persistant and dont take no for an answer. ANYTHING that you had and still have problems with while on active duty they are responsible for your care for the rest of your life.

                          Jean ann

                          Comment


                          • #14
                            Originally posted by CarolinaGal View Post
                            My husband is getting kicked out of the USMC because of IC so you are lucky to be able to stay in SemperFi. They began his discharge paperwork as soon as he got a diagnosis because IC is a medical disqualifier.
                            You can get kicked out of the military due to a medical condition?? I didn't know that. My dad is retired US Army. He retired as a Lt Colonel.

                            I know that with adult children Tricare covers until age 23 IF they are in college full time, but now it covers till age 26. I was a full time college student for 5 years. I miss Tricare I know of a young woman who is 33 years old, unmarried, and has a child but STILL is under Tricare. No clue how she got that. Her dad is also retired US Army as well. She doesn't have any disabilities like IC or autism. I read something on Tricare about autism. I don't know if I can qualify. I have aspergers and learning disability. Maybe the young woman has Tricare still because she's not working?
                            In memory of my beloved best friend in the whole world! Timmy (West Highland White Terrier)
                            11/24/04-9/5/2011


                            God Bless,

                            Anna

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                            • #15
                              Hi, I have Tricare Standard. You can for sure get kicked out of the military for health reasons, my husband has high blood pressure and really has to watch it. We extended beyond 20 years, but hope to retire in three more. Then we will go on Tricare for life. For retired people.

                              I see you live in Fairfax, VA. We are supposed to be moving there in June of this year after my husband is done with this military school. Could you PM me and let me know where to go for IC related things? And where the best places are to live?

                              I don't know how that lady got Tricare unless she was married to someone in the military and divorced. I don't know if Tricare will cover someone that old under a parent (unless there is some kind of disability or something).
                              Teresa

                              We are not HUMAN BEINGS going through a temporary SPIRITUAL EXPERIENCE. We are SPIRITUAL BEINGS going through a temporary HUMAN EXPERIENCE....so that we may become more SPIRITUAL.

                              Comment

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