Therapy Thursday: Tricare Changes to Renewing Therapy Services


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Between three children, there are 7 therapists. So there is never a shortage of company at my house. They no longer use the front door and don’t even knock when they walk in through the garage. I like it that way. If they are going to spend more time in my house than my husband, I want them to feel like family. So it was no surprise to me when I received a call after hours from a frantic therapist.

She was bewildered and confused. She explained that Bugs renewal of his referral was denied. Strange due to the fact he has had these services for the last four years and his prescribing doctor had just told us we needed to keep up with Bugs therapy services at our appointment only a week before. I told he therapist I would call our insurance first thing in the morning to figure out what is going on.

I did just that. Insurance explained to me that Tricare now has a new policy in effect for renewing or obtaining services. Before, a therapist would simply do an observation of the patient and send it into the insurance as proof they still needed services. Based solely on the therapists recommendations, Tricare would approve the renewal. However, due to abuse of that policy, Tricare now requires the doctor AND the therapists to both submit reports. This new policy that was not explained to us resulted in two weeks of missed services and numerous phone calls between the doctor, therapist and insurance to make sure everything was done properly.

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Tricare/ Therapy Thursday…Thank God for insurance!


So, I am guilty as the next gal of complaining about our insurance.  Maybe we get too much junk mail from them, it takes too long to get a reply back when I send an email, I spend a lifetime on hold, etc., etc., etc.  But the truth is, my kids wouldn’t be anywhere near where they are without the therapy they’ve had.  And to continue being honest, there is no way my husband and I could have afforded that therapy without the insurance we have.  Here is one bill that covers a one-month period for just one of my boys, for just one of the types of therapy they receive.

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The amount billed to the insurance was the $955. Our co-pay was $45.

We got another bill recently for both boys for their ABA services the entire time we lived in Arizona (about 8 months or so).  The total was almost $20, 000. 00  Seriously.  Like I said above, even if I went back to teaching and somehow had three jobs, we couldn’t cover that.  So, I’m taking this as a wake-up call and reminder to be thankful for our insurance.  I’ll try to keep it in mind the next time I’m on hold for eons.

 

Tricare and Therapy Thursday: Medical Radius


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When we were awaiting orders we dreamed at all the amazing possibilities for our first duty station. I never dreamed I would ever move away from my home town, let alone, home state. Then there we were waiting to see if we would be moving to another country. When the word came in it was a like a bomb had gone off. We didn’t know what to think or how to react. We were scrambling to pick up the pieces and quickly get our affairs in order. We didn’t get Germany as we had always dreamed, and what we did wasn’t even on our radio as a possibility. But there we were faced with a realization we needed to get packing… and fast.

One of the steps you take when moving to a new base is often clearing EFMP. If you don’t know what EFMP is, take a quick read over at a article we wrote a while back.  For the rest of us, lets move on.

During our personal process of EFMP screening when leaving our last post we had to go through the EFMP clearance process. What we told was a scary realization we had not realized was going to be a issue. Due to the medical radius of the base we were currently at, we, as dependents, were told we could never reside there again (there are always ways around this). Why? The medical radius for that particular base was 40 miles. Care for my child had to be within those 40 miles. It was not! It was a 3 hour one way drive to a larger city to find the medical specialty he needed for care and his weekly medical treatments. That’s right folks. I was drive 3 hours one way for a 30 minute appointment 2-4 times a week! A WEEK!!!!!

So the questions come. I know your thinking them.

1) How were you still stationed at the post if you were traveling outside the medical radius that often for care?

Our son was diagnosed with his medical condition after we had been stationed at the base. They were in a frantic search for someone in the state to be able to manage his care. Due to the isolated location of the base, honestly, there was no medical care within the 40 miles. So (here is where an exception comes in), somewhere along the lines they approved his EFMP paperwork that stated he needed said medical care outside of the radius. It seems however, some where along the way no one really noticed how far we were driving. Upon exiting and pcsing from said base, this is when they caught it and said there was no way we could live there as dependents.

2) If you can’t live there as dependents what happens if your spouse is stationed there?

Great question. No real answer. We have yet to reach that point, but I have a feeling we are going to get our answer shortly. Due to the high specialty of the medical care Bug needs and the combination of the MOS Hubs does, we are very limited to bases that can accommodate both. We are literally currently trying to figure this out. However, from I have have been told in the past it would resemble something like an unaccompanied tour for Hubs. Which will not fly with me. Sorry, but separating me and three small children (all requiring specialized care) from my husband will require you to sedate me and lock me up. All that will do is create more hardship on my family. I would rather drive 3 hours for a 30 min appointment to be able to keep our family together. But there in lines a greater question- would staying together do you more harm than good?

3) What is the medical radius for my base?

In order to find that out you will need to contact your base or your gaining base EFMP office. Every base is different. Some bases have larger radius than others.

4) What will happen if you can’t find a base with medical needs and your husbands job?

Another amazing question and another one I am in the process of discovering. Where there is a will there is a way. The way? Talking to my children’s doctors and explaining to them the situation.  If we are having this issues, I am sure other families in the past have had similar if not the same issues. And I am sure the mommy in that family was just as feisty as me to find a way to make it all happen.

5) Do you want to move?

That is the question of the year. I have also wrote about this a bit earlier this year; the first time we were told we were pcsing (which was a lie!). We are now facing the same situation again, just a different base. Yes, we want to move. There are so many reasons that will end up being another post.

Ideally in the end we will move to a base that will have both the medical care we need and Hubs job. Realistically that will probably never happen and we might be stuck in paradise forever. If not paradise forever, then an base with limited medical access that will require weekly road trips but our family will be together.

Tricare/Therapy Thursdays- Myths About EFMP


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I got some “great” advice when we first entered the Army- Dont register for EFMP. <— that was sarcasm, did you see that? Because signing up for EFMP is the real great advice. But your probably asking what the heck is EFMP.


According to Military One Source

What is the Exceptional Family Member Program?

The EFMP supports military families with special medical and educational needs. The program has three components:

  • Identification and enrollment of a family member with special medical or educational needs
  • Assignment coordination to determine the availability of services at the projected duty station
  • Family support to help families identify and access programs and service”

EFMP is a confidential program. It is on a need to know basis. Basically it’s main purpose is to assist with assignment purposes only. Enrolling in EFMP will not increase or decrease your chances at unaccompanied or accompanied tours or deployments.

In order to enroll in EFMP here are some helpful forms:

DD Form 2792

DD Form 2792-1

Ok, now that we got the basics out of the way, lets talk about some of the myths; including the reason behind why I was told to never go on EFMP.

Myth 1: Your husband will never be promoted
This is the reason I was told as a brand spanking new Army wife to never enroll a family member in EFMP. I was told the reasoning was because if we enrolled in EFMP, it will show the solider has to much going on in his personal life to be able to handle the tasks and job in the Army.

Myth 2: It limits your duty station; in so facto, limits promotions
This is one reason you need to enroll in EFMP if you qualify. By enrolling in EFMP you will be ensured that you are only PCSed to locations that can handle your medical needs. Every base has a radius of medical care doctors, therapists, and the like have to be within. Example: While stationed at Fort Rucker, AL, we were told upon our overseas EFMP screening that Fort Rucker’s radius for medical care is 40 miles. They explained that since care for our son was over the 40 mile radius, as dependents we can not be stationed at Fort Rucker again. However, Hubs can still go to Fort Rucker for schooling, classes and presumably be stationed there. As dependents we would have to find alternative lodging. So I was shocked when we got orders to Hawaii. I underestimated the medical system here. “Tripler Army Medical Center is the only federal tertiary care hospital in the Pacific Basin”, per TAMC’s website.

Myth 3: EFMP is only for the severely disabled
Um, no. All three of my children are on EFMP. They walk, talk, eat and poop just the same as you and me (well, mostly). Enrolling them on EFMP was to ensure that when we did PCS from Hawaii, we would move to a place that meet all their needs for medical and therapies. That, however, does not mean medical and therapies will be open when arriving to our new duty station. I know for certain there are wait lists at specific bases for ABA and respite.

Myth 4: Being on EFMP puts you first on the priority list for housing
Oh, how I wish I knew about how that worked when we moved here (and lived in a hotel for 59 days). Enrolling in EFMP only means there are needs that need to be meet. And as you know, everyone has different needs; not everyone needs are the same. For example, I have three kids with three different reason for enrollment on EFMP. With that being said, you need to submit your paperwork to housing for them to make the judgement if you qualify for special housing or priority on a wait list. Had I known this we would have been bumped up on the wait list. In Hawaii, they then submit our EFMP paperwork to the medical board who makes the decision whether or not we need priority or special housing. To find out what paperwork is needed, please call your housing office on post. I suggest calling before you PCS so you can make sure you have all needed documents on hand or if possible provide them ahead of your arrival.

Myth 5: Being enrolled in EFMP makes the service member non-deployable
HAHAHAAHA! Sorry for laughing, but I can tell you that my husband just did a 12 month deployment and we have three (two at the time) children on EFMP and one has a life-long, life-threatening condition. A service members status is always deployable.

Just remember the service member is at the needs of the Army. The EFMP is to help the family members enrolled. Giving the service member the reassurance that his/her families health needs will be taken care of at their duty station makes a prepared and ready service member. My husband found solace in knowing that his family was taken care of when he deployed. And he finds that same solace in knowing when we PCS again that we will only go where our children will be taken care of. Even if that means accepting another tour here. He has never been told our EFMP status has effected his work or his promotion status. And most people at his work do not even know that he has three children on EFMP.

EFMP can be a great source of help and assistance. Please don’t be afraid of enrolling, and actually you HAVE to enroll if you are instructed to by your doctor.

Her & Nicole

We Hit a Growth Spurt!


If this is your first time finding us welcome! You can learn more about us and who we are under “Crazed Authors”. If this isn’t your first time here you may notice a few changes, in particular, our categories and blog mission.

We changed our focus {mission}. We started this blog with a few ideas and just wanted to see how far those ideas could take us. It took us far! Farther than we expected. However, after a few months I realized I hadn’t really hit the head on the nail. In other words; I didn’t accomplish what I had intended to do. So this past weekend I went back to the drawing board and with the help of the amazing Mrsmissioncontrol; did a little fine tuning.

{Mission}
We’ve noticed a shortage on blogs about military families who deal with the day-to-day of having kids with special needs, and autism in particular. We want to try to fill that space and maybe offer hope, share our lives, and encourage some other families out there.

Additionally, we decided to go to a “theme day” format. Why? It will help us focus more on the topics we intended to write in relationship to our blogs purpose. I restructured the categories to help include all the facets of life we deal with as military families and families of special needs kids (focusing mainly on Autism); from explaining military terms, insurance lingo, new Tricare updates and more.

New categories –
Mommy Moment Mondays: Monday mornings can be rough for everyone, including us. We will try to help you ease into the week, share our new fave finds, and discuss some of the crazy trials and tribulations of parenthood. If nothing else, maybe you can get a laugh as we share an embarrassing story or two. Or twelve.

Tip{py} Tuesday: Tuesdays will bring useful tips in the world of cleaning, parenting, and basically running the world. This is also where we will share any cool DIY projects we have done or hope to do.

Wordy Wednesdays: Alphabet soup anyone? ABA, DONSA, EFMP, ASD, PDD-NOS, IEP…WHEW! Between special education and military life, all those acronyms can be confusing!!! We will run the maze with you as we try to decipher this whole new language.

Tricare and Therapy Thursdays: Insurance and therapy are two very important things for special needs families. Thursdays are when we will cover important Tricare information and news, as well as information we have come across regarding the numerous therapies (namely occupational, speech, and ABA) for kiddos with autism and PDD-NOS.

Foodie Friday: We’ll head into the weekend with great recipes, especially those for those on a gluten free (GF) or gluten free casein free (GFCF diet). We don’t post recipes unless we’ve made them, so rest assured they are mom, kid, and family-tested and approved.

Whatever Weekends: We are tired too, so no promises for specific topics here. We’ll share when there is something worth sharing and take a break when there isn’t.

I am sure this won’t be the last growth spurt we have. So please be patient with us as we learn and grow. It is like when your kids finally learn to button their shirt…the day they grow out of it.