Therapy Thursday: Stuck on a Ride We Can Never Get Off- Tricare’s ABA Policy in the News Again


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We, as parents of children with special needs, boarded this roller coaster of emotion sometime back, assumed at one point we could get off. Ok, maybe I am the only parent who thought this and now reality has adjusted my once jaded view, but I am getting tired of these hills and valleys we ride. And I am not talking in reference to my children. I am talking about what we all must do to provide them with the treatments they might need.

So prepare yourself this coming July 25th when Tricare once again throws another 360 loop onto our rails.

In an article published June 18, “Tricare is consolidating its disparate autism therapy programs into one Autism Care Demonstration Project for children of active-duty, retired and reserve component personnel starting July 25.”

So there you have it folks. Make sure that seat belt are tightened and all arms and legs remain inside the cart at all times. Although it appears for now the ride won’t get much more bumpier; it’s never smooth sailing.

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Wordy Wednesday: Transferring Your Prescription During a PCS


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Yea, you caught me… “Transferring your prescription during a PCS” is not a word. However, it is a aggregating phrase to hear during an already aggregating time of a PCS.

Here’s my story- two months ago I called Tricare and then Express Scripts regarding our families growing list of prescriptions. I was informed “it’s a piece of cake!” And to not worry about it until we have moved and settled down. Ok, so I tried to let go and live with God (a phrase my mom used to say). Flash forward to this past Friday when I ran out of two medications. I quickly called our local pharmacy in town. They informed me I needed to do a transfer of all my prescriptions. Huh? The issue I ran into is I ran out of my prescription while visiting family and before we reach our new duty station. I need to transfer my prescriptions from a military pharmacy to a civilian one.

However, to further the issue, the pharmacy doesn’t take Tricare. Apparently two years ago Walgreens lost the Army contract to take Tricare and has been fighting ever since to gain it back. So I had to call the next pharmacy in line; CVS. CVS takes Tricare for your information.

I dialed up CVS and explained my situation. They were happy to have my business. Then I realized the next hurdle. I needed my medication before I went out of town for two days. I thought if I’d transfer my prescriptions to one CVS, I could pick them up at any location. Guess again. Maybe I am naive. Nevertheless, I had to wait until we returned to town TODAY to pick up my medication. For two reasons 1) you can’t pick up your refill at just any location and 2) most military pharmacies aren’t open on the weekends. So when you call on a Friday trying to get a prescriptions transferred, you need to allow for 24 hours before pick up.

So learn this lesson from me- once you arrive at your new destination; call and have your prescription transferred before you run out of medication.

Wordy Wednesday: Tricare ABA; Let’s Beat a Dead Horse


Yes, I know. We have touched on this topic before…like 10 times. You read it in your social media feeds almost daily with all the changes, laws, and rants about it. So why am I sitting here wasting your time again? For the same reasons I did last time. Things are a changin’.

First off, let me provide you with this freaking awesome chart explaining the differences in the Tricare ABA programs there currently are- Tricare_ABA_Comparison_Chart_March2014 that was American Military Families Autism Support Community (AMFAS). I belong to the one in our region and the group for the region we are moving too. They each have their own Facebook pages and support groups by location. I’m a big advocate of being able to communicate when you need to communicate immediately to answer questions. I hate mulling over a question I have waiting for a office or store to open their telephone lines or doors. I love social media because I can almost instantaneously get an answer to my question.

I am linked to AMFAS via Facebook and yesterday a new meme caught my eye and sent me into a panic reading over their article.

AMFAS.ORG had that scrolling across my Facebook account. GAH, FFFFFT! Those weren’t exactly the words I used. But for the sake of not offending our readers, I will keep it PG. Enter a few eye rolls and I was more than a little irritated. Riddle me this Batman, didn’t we just go through changes. Changes that were so unrealistic and ridiculous, that they were resended? Um, yea. So why are trying to do this again? Nevertheless, a Tricare ABA consolidation program is coming this year.

I do understand that some of the retirees are not getting the level of care they need and qualify for and there are a few other issues arising from the current programs. However, the more I mull it over I realize this is basically Tricare trying to cut costs again and streamline programs. AMFAS provided two links to reports given to congress

Report 1

Report 2

 

Head on over to AMFAS for more information regarding the Tricare ABA consolidation program.

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.

Therapy Thursday: Does Tricare Cover Pediatric Orthopedics?


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I’m on a new journey with one of my kids. One I have never been on. I thought we had been to every medical specialty there was; from allergy/immunology to oncology. So when we were sent to a pediatric orthopedist I was a little nervous. So nervous, I took along one of my children’s ABAs who could translate for me. My mind tends to go blank during appointments with all the information being thrown at me.

Tip: It’s not uncommon for me to break out my phone to voice record (with everyone’s consent). This way, when I recount the conversations to Hubs he gets a larger picture than just my memory (which we know is crap).

So here we are at a new specialty, with a new kid. But what had gotten us here?

Of course with two dx older siblings SB has been and is watched very closely. Not to mention her brother and sisters rare auto immune diseases; she is tested yearly. So it should have been no surprise when a doctor asked us if we had any concerns with SB; because he did.

Concerns? Well she almost died from RSV at a month old; spent a week in the hospital. She has now developed serious asthma. She didn’t make a sound until this past October, when finally Bugs ABA agreed with me I wasn’t crazy for my concerns and I took her in for a hearing test; which she failed. A month later she has tubes put in and has finally started making some words and nosies. She did the Army crawl for several months before she finally started walking late. Up until that point we always made the joke how she was born with toes that were perfect for sandals. There was almost a inch gap between her big toe and second toe. Little did we know what that physical meant for her.

When she stated walking we figured it out. In my dad’s generation it’s called “pidgon toed”. Nowadays, it is referred to as “in toeing” or tibia torsion Regardless of what you call it- it is where her leg bones below her knees are formed inward. So her knees and feet face in; causing pain, muscle weakness and muscle tightness.

So we (it is hard to get a 2 year old to do pt!) were given pt once a week for a hour at a time. I have seen a difference. However, one hour a week will not correct the problem. After seeing the orthopedic surgeon, she told us the answer was breaking our child’s legs.

Say what?!

Um, yea. Otherwise she said there was no option. Sorry! Don’t agree! And neither does the pt. We are now waiting on a second opinion to come through.

If you read the link you would see where they don’t suggest surgery until after age 8. We are going with these guidelines; however, due to the degree of her condition doing nothing is not an option. I’m sorry, but my parental intuition tells me something can be done to help (not cure) her. Currently she can’t walk up stairs, gets a few bloody noses and a multitude of bloody cuts from falling.

Lucky for us, we are surrounded by some amazing people. SBs pt went to a class last weekend and spoke about SB. There are options for us! We are very excited. Breaking our little girls legs just seemed, so, um, not right? I don’t even have words to explain it. The biggest question is- will Tricare cover it?

We were told by SBs pt that due to us at a peace time, they are more tighter on what they approve. Ehh?

I don’t have an answer. But what I can do it keep you all updated on what will happen. I will find out. And I will share my findings. Until then, wish us luck.