So... I have a buddy who has a really sick kid. I haven't asked exactly what his condition is... I feel It's not my place. Well I was under the impression that the ARMY covered everything for family members, but this family is paying upwards of 1000 dollars of out-of-pocket expenses for his medical bills monthly. My buddy is a SGT, so he obviously isn't doing too well financially (is was manageable, but the kid is getting worse) He is too rpoud to ask the ARMY for more help, so I was wondering if anyone knows a direction I could point him in. THey are missing electricity payments, and even if they took out an AER loan they couldn't pay it back. Any advice at all would be nice. Thank you!

He could go to AER and try to get a grant. He wouldn't have topay that back. However the situation raises the question of whether or not he has informed his chain of comand. If the child is registered in DEERS and the Soldier is the child's sponsor, it wouldn't matter if the kid had a brain tumor, tricare would cover it. Might be a little bit more to the story

All I know is the kid is in constant pain. He is like a little son to me, and the family is like my own family.

I thought Tri Care covered everything.
But my prayers will be with that family.

As far as I know tricare covers everything, however if, for what ever reason they aren't taking care of this kid, I'd get the media involved. Trust me nothing gets things done faster than negative press. Not to say tricare would totally revamp it's policy right away to accomodate this particular situation, but if money is the major issue, outside of having a seriously ill child, some media coverage might be able to remedy that.

The problem is probably that he is on Tricare standard instead of Tricare prime. After about 90 days if you don't go and purposefully have the child re-enrolled into Tricare Prime then they will automatically fall under Tricare Standard. If they are sure that they are enrolled in Tricare Prime and make sure that the child is under Tricare prime then they need to speak with Tricare about any bills they do receive.

The way Tricare Prime works is as long as you have a referal, and you are sent to the physician and receiving care prescribed by said physician then there is no deductible or co-pay. Tricare makes a deal with the providers that for Tricare to send you to them then they will accept whatever Tricare feels is an appropriate payment is what they will accept without billing the beneficiary. The physician's office takes the excess billing amount and uses it as a "write-off" at the end of the year.

Basically, they need to make sure their child is enrolled in Tricare PRIME and if he is, then they should then contact your Tricare office on post with all of the medical bills they have received. If he is enrolled in Standard instead of Prime, then they will have to pay what they have accrued and need to enroll him in Prime prior to the 20th of the month for it to take effect on 1 Nov.

In addition to being on Tricare Prime, it sounds like this child should be on the Exceptional Family Member Program if he isn't already. Both my wife and son are enrolled, and through EFMP and Tricare Prime, we have no problem getting to the specialists we need to see, and we almost never pay out of pocket for anything besides medication. It looks like it's been awhile, hope everything's going okay with your friend and his family. You're definitely doing the right thing by tactfully seeking help for them, no Soldier or dependent should be without the care they deserve. My family and I will keep your friend's family in our prayers. Let us know how things go.

Get this soldier to Tricare now, not later. My son was in Pediatric ICU for a week and the statement was more than $22,000 for the stay. Not the surgeon, not the lab, not x-ray, just to stay in the bed in the hospital. All I had to do was show my ID card and it was all taken care of. About a month later I get a bill from the Radiology place saying I owe them for the amount that Tricare did not pay. I took the statement to Tricare and they told me that they had been having problems with this place for trying to bill soldiers after Tricare had already paid. Tricare made a phone call while I was there, and the matter was handled by the time I left. The question is, how many people would have or did just pay the bill because they did not know any better?

There are many factors that can lead to this. Prime and Standard were mentioned, and also there is the issue of whether or not the hospital/provider accept Tricare. Does Tricare even know the child is being seen offpost? They can't pay if they're not billed.

This Soldier needs help ASAP. Even if you have to intervene and get with his COC, ACS, Tricare or all of the above. No Soldier should be paying so much money for his child's health with so many health resources at our disposal. Help him now.

?

Used my buddies computer to post jst barely... guess he was signed in... Anyway they are getting the runaround on getting the kid on EFMP, which is totally ridiculous. The bills stem from the cost of the meds I guess, which is asinine. The kid will pass on in a horrific way if he doesn't get the meds, so why are they out of pocket? It's not like "oh i've got a frakin backache, let me get some percaset". Hell die. DTS won't even cover their expenses (like they should) when they travel to the kids specialist.Anyway... Thanks for all of the help, and Ill let them know people are keeping them in their prayers. EDIT: forgot to mention the guy is also a SGT, not in my company, so it makes it more awkward and difficult for me to assist him. Stepping on toes was never my thing, ya know?

The only way he would pay more then nine dollars out of pocket per month is if the meds are not approved by the FDA. Is this guy an ACTIVE DUTY soldier? Does he have referals from his kid's PCM to go to the specialists? I understand the whole not wanting to ask for help thing but seriously, he needs to look into it because as has been said, there is no reason for him to be paying so much for stuff if he has done all the paperwork. EFMP or not, it shouldn't break the bank as long as he is active duty and enrolled in tricare PRIME.