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Marine Corps Logistics Base Albany


Marine Corps Logistics Base Albany

Readiness Enabler for Operational Forces  •
Humana helps military families maximize choices

By Ms. Susie Stevens | | February 9, 2006

Navigating the choices of health care plans can be difficult for any person. This includes military members or their spouses choosing a TRICARE health care plan or using their benefits.  For that reason Humana Military Health Services operates a TRICARE walk-in customer service center at the Naval Branch Health Clinic Albany.  The center is open Monday-Friday from 7:30 a.m. - 4:30 p.m. for TRICARE beneficiaries who would like to speak to an expert on how military personnel and their families can maximize their benefits. 

Teresa Williams is one of three employees who work for HMHS as a beneficiary service representative.  Williams, the spouse of a former active duty soldier, now enjoys her TRICARE benefit as the wife of a military retiree.  Williams has more than 25 years experience navigating her choices of TRICARE health care plans with military precision and helps ensure her family maximizes their use of this valuable benefit. 

She will share her knowledge with any active duty military member, spouse of a military member or retiree.  She speaks from experience when she helps families with their choices and other subjects such as: choosing the best plan for your needs, enrolling in a plan, help with preparing the paperwork to file a claim or reading an Explanation of Benefits form, helping patients find a doctor and getting authorization to see a specialist.  Williams often briefs units, family members, new active duty members and retirees on these subjects. 

She also helps families learn how to use their TRICARE benefit after their spouse leaves the military or retirees who may not be using this benefit to its fullest.  Williams has learned from her own life that it’s much better if the spouse of the retiree takes an interest in TRICARE. 

“It is usually the spouse of the active-duty member who takes the child to the doctor.  If the spouse understands TRICARE it goes much better for a two-parent household.  Also if the retiree (sponsor) dies their spouse can continue on with their TRICARE benefit independently if necessary,” Williams said.

Williams recommends that TRICARE beneficiaries bookmark these important online help tools that are available everyday, 24 hours a day, that provide the same valuable services that Williams provides.  The hotline is the Central Beneficiary Service Line at 1-800-444-5445.  Customers will notice the line has an automated telephone tree, but only because it serves to direct the customer directly to the subject matter expert with a particular question.  Customers will always get to speak to a subject matter expert if they’ll follow the options the phone tree provides.  Two valuable Web sites are www.humana-military.com and http://tricare.osd.mil.

Linda Gunter, TRICARE Service Center manager here, has worked at the base clinic for four years and also provides assistance to customers. 

“I would like active-duty military personnel and their spouses to know we’re here to help them understand their benefits and maximize the use of them,” Gunter said.  Some recent changes in the TRICARE Next Generation of Contract in 2004 that Gunter highlighted are: revised financing, this means each Military Health System has a budget they will manage for the expenditure of healthcare. Revised financing has changed how healthcare is managed.

“Patients will notice that their individual healthcare providers will increase utilization of available resources in managing health issues in-house before sending the patient out for more costly specialty care. The patient will receive all the care they need to manage their health issues, but the primary care manager will now have a larger role in management of the care. The patient will also be expected to play a more active role in their health care needs. Emphasis will be on preventive care. Taking care of problems before they become a major issue,” Gunter said. 

The military is stringent in managing its health care budget.  Customers should understand it’s because every dollar spent comes out of their budgeted healthcare allowance. Patients may notice this when their primary care manager orders lab work and an ultrasound instead of a more costly computed tomography scan as first line medical investigation.  If the CT scan is needed after the other tests have been performed, it certainly will be done. The change is that the CT scan will not be the first line investigatory tool. Rest assured though, patients will receive whatever needed care to restore or maintain their optimal health status.

If a TRICARE beneficiary chooses to go to the emergency room the prudent layperson rule applies.  If the visit is coded without an emergency room diagnosis that claim will process as a point of service due to inefficient use of resources, Gunter said. The complaint needs to match the necessary level of care. This type of thinking has been used in the civilian sector for several years with success. In the era of revised financing for the MHS, patients will need to become more savvy about the use of medical resources. For most instances an urgent care center will suffice. The TRICARE Service Center will be glad to review or explain any questions a patient or provider may have regarding delivery of healthcare.

Customers who would like to call HMHS and speak with a TRICARE service representative can call 1-800-444-5445.  Please call if you need help and cannot make it into the branch medical clinic here to speak to an on-site representative.