‘Choice’ explained

Baker Theater on Fort Leonard Wood filled up quickly Tuesday afternoon as many members of the military community came to hear about changes to their health care policy and have questions answered.
“The Choice is Yours” campaign began earlier this year and was initiated to help alleviate over enrollment problems at General Leonard Wood Army Community Hospital (GLWACH).
Col. Judith Ruiz, GLWACH commander, addressed the crowd of active duty soldiers, retirees and family members.
Ruiz encouraged those in attendance who haven’t joined the program to do so.
“The Choice is Yours” allows TRICARE beneficiaries to select a primary care manager (PCM) other than one at GLWACH. Active-duty soldiers must enroll with a PCM at the hospital, but their family members and all non-active duty TRICARE Prime and TRICARE PLUS beneficiaries can take advantage of the offer.
“The truth is we are currently over-enrolled by 14,000,” Ruiz said about the current patient load at GLWACH.
Only 1,004 people have signed up for  physician care outside of GLWACH so far. The campaign ends today, although Ruiz said she was considering expanding it until Sept. 1.
“There comes a point where I can’t continue to serve the population,” she said. “We are working arduously to be able to serve you and this community.
“I encourage you to do it (sign up for a civilian network PCM) and do it as quickly as possible,” Ruiz continued. “What we’re doing now is probably something we should have done a little earlier.” 
While the program is not new— other military installations across the United States took similar measures years ago to address growing populations at installation hospitals— it is the first time it has been offered at Fort Leonard Wood.
“Fort Leonard Wood previous commanders never allowed you the choice to do this,” Ruiz said, noting that if people decide to remain at GLWACH, they will continue  to receive the same care they have in the past.
“I think you guys deserve the very best,” Ruiz said, adding that the “very best” includes continuity in care.
“The best opportunity for continuity of care resides in the network,” she said.
Ruiz spoke to the issues the military faces in keeping physicians during a war period, specifically of the turnover in hospital staff due to deployments.
Ruiz said while she is actively recruiting to help shore up the shortage of primary care doctors, it is difficult to attract people to rural Missouri.
“If you live in St. Louis, great,” she said. “But if you live in St. Robert, it is a challenge to attract providers.” 
Mentioning emergency waiting room times at GLWACH are sometimes up to eight hours long for patients, Ruiz said the problem is a direct result of the lack of primary care doctors at the facility.
“The emergency department is never understaffed,” she said. “(But) because I don’t have enough primary care providers, you are going to the emergency room.” 
For active duty family members who take advantage of ‘The Choice is Yours’ program, there will be no co-payment required for services.
There is a $1,000 catastrophic cap for each federal fiscal year (Oct. 1 to Sept. 30) and co-payments for prescriptions remain the same.
TRICARE Prime beneficiaries pay $460 a year for coverage and will experience a co-payment increase if they choose to receive care from a network provider.
A flat $12 co-payment is required for services and a $30 co-payment is collected for emergency room services.
There is also a $3, 000 catastrophic cap for TRICARE Prime members. Co-payments will count toward that cap.
TRICARE Plus members, which includes the population age 65 and over who also qualify for Medicare, will have no co-payment required for seeing network providers as Medicare is the primary, and TRICARE the secondary, insurance.
For those who decide to enroll with a PCM off post, the referral and authorization process will remain the same.
Additionally, those not satisfied with their choice of PCM may change providers up to twice in a year.
Participants are also required to remain in the program for one year and have the option of going back to GLWACH if enrollment is open at the facility.
“Access is based on priority,” Ruiz said, noting that permanent party active duty members are No. 1.
Services are available in the immediate and surrounding communities for those who want to utilize the option being offered, Ruiz said.
“Those providers want your business,” she said, noting that health care is very expensive and many providers are letting physicians go because there is not enough demand.
That demand, however, Ruiz said, is there, but hasn’t been realized because TRICARE beneficiaries were never given the option to pursue those services in the past.
Services, like urgent care centers, she noted, will end up increasing once the demand for those services is proven in the community.
“They’re looking for you because they need your business,” Ruiz said.
More information about the program can be obtained by calling 1-800-TRIWEST (874-9378) or by stopping at the TRICARE Service Center, Bldg. 470, Fort Leonard Wood, or by visiting the online center at  www.triwest.com.