USFHP versus Tri Care For Life

[Wayne M]

I am presently using USFHP (United States Family Health Plan) for medical purposes. They have changed their "coverage area" over the years and presently cover Texas and Louisiana. Any other state requires prior-authorization.

On a trip to Florida my DW was taken ill. I called USFHP and they said that there was an Urgent Care facility attached to the Naval Hospital in Pensacola. We went there and I provided my USFHP card. They could not find us in the system (USFHP is part of the contractual part of Tri Care for Life - where Medicare pays 80% and USFHP the remaining 20%) I then decided to do what the TCFL web site said to do, I provided my ID card and Medicare card. They still could not find us in the system. Not only that, they could/would not treat her. This Urgent Care facility is staffed by Military and Civilian personnel. We ended up going to an Urgent Care out in the community.

As RV'ers we travel to all parts of the U.S., and I am going to find a way to dis-enroll from USFHP and use TCFL. I see where there are two regions, East and West.

Question for anyone using the TCFL. When you cross from one region to the other what do you have to do to use TCFL?


p.s., Yes, we were and still are in the DEERS system.

[Lv2Roam2]

We're FT on the road and have used our medicare/TFL benefit literally across the country - for urgent care, major surgery, specialty and routine visits, and immunizations. Our home of record is South Dakota.

There's been no hesitation by any service provider to provide care. I carefully review all Medicare and TFL explanations-of-benefits (insurance authorized / paid) and have seen zero impact of geographical location of care. We have never communicated with TFL or any sub-contractor.

We've been particularly pleased not to have to get prior approval for specialty care referrals, especially with some significant health issues this year. Caution: you do need to ensure a valid medical need. It is reasonable to me that someone might decline to pay a bill for frivolous medical visits.

Now ... let's see what others have to say ...

[tbos1958]

I will be on TFL in a couple years and full timing, so I’m following this thread.

[flywithcoop]

We have had Medicare and TCFL for several years. My wife has been in and out of hospitals 4 times in the last 18 months. she has a rare autoimmune disease. I love Medicare and TCFL. We have never been denied medical treatment anywhere and have never had any out of pocket expense. Both have been absolutely fantastic. My wife has been billed millions of dollars in medical benefits since we got Medicare and TCRL and we have not spent a penny. 4 ten day hospital stays. One immunity treatment is $60K. and she has had more then 10. We no longer travel nationwide due to this horrendous disease and barely get to use the MH a couple times a year. However there is light at the end of the tunnel as she will enroll in a drug study this week. This drug will cost $500K annually and will be covered by Medicare and TCFL.

[Dennis4809]

Medicare and TFL. Used in WI, FL, IN, AZ, and WA over the years. No question and no out of pocket. Works well.

[Wayne M]

I am on TCFL with USFHP as their contractor. With USFHP the Medicare card is NEVER presented just the USFHP. USFHP then bills Medicare for the 80% and pick up the left over 20%. Has worked well for many years and then things have changed if you read my first post. Wife has breathing issues if she gets bronchitis or a sever cold and need antibiotics. We were denied care at one Urgent Care facility (see first post).

I checked Deers after posting and we are in the system, however it states USFHP and when that is stated the typical way of Mil ID and MedCare cards just don't work.



Steve. I like your answer, need to hear more from others traveling between regions and using the TCFL (Military ID Card) and Medicare (Medicare ID card) as insurance. The information I have read on TCFL web pages state that pre-authorization is needed if "out of region."

[Dennis4809]

Haven’t heard anything about region or out of region. Just show the Medicare card and our ID. Never have preauthorization and have never had a problem. As I stated earlier, we’ve used this combo all over the country. Until this post, I’d never heard of USFHP.

[Wayne M]

Thanks Dennis.

I'm sure others have looked it up but it is a contracted TriCare for Life addition. I retired in '84 and for 35 years have used USFHP. It has been good with the exception of the last few years. The region has diminished considerably and now only incorporates Texas and Louisiana under the Christus system. Anywhere else a referral/authorization is required.



I'll be switching soon.


One other question. Are annual vision exams included in TCFL, or does one have to have the FEDVIP insurance?

[Lv2Roam2]

TFL does not cover routine eye exams - it does cover some exams for medical conditions like glaucoma and injuries. A quick search on the Tricare website provides much more detailed info. We use FEDVIP dental and vision and have been very satisfied with the products / process.

Just FYI: VA has a very good eye benefit (exams, glasses included) - not all vets qualify so a discussion with a Vet rep is important.

[Ray,IN]

Wayne, Medicare takes care of our eye exams and any surgeries (cataracts, etc),TRICARE pays any difference-our total cost for corneal implant surgery was ZERO , however neither Medicare nor TFL will pay for corrective lens, (glasses, contacts). I have FEDVIP dental plan, which also has a vision plan(I did not subscribe for vision).
This is supposedly the same plans available to Congress.

[Bill 3rd]

We have USFHC. When in Fla, my wife needed care. She was taken to the emergency room in Florida hospital, USFHC paid the whole bill, no questions. Another time in Fla, I took her to an urgent care, they paid it all. To make sure, I called them and was told they would cover it. With USFHC, you are too seek care outside of Military hospitals, you won't show up in the Tri-care system. If you have USFHC and Medicare, do not show your Medicare card.

[Wayne M]

Bill, Thanks and I know all that however the Urgent Care, same frontage as any other Urgent Care is attached to the Naval Hospital in P'Cola. They take TCFL. It is "Urgent Care," not "Military Hospital." They just happen to be attached. They could not find me in the system.

USFHP has said that Urgent Care can be used but if you are out of the region you have to get pre-authorization from you primary care doctor, or USFHP. I did that and still go billed.

Yes, any emergency care can be sought at any hospital, and I think including Military, but it has to be an emergency.

Seeking care outside a military hospital is covered by TCFL. No need to register according to TCFL web sit, just show military ID card and Medicare card at facility/doctor participating in the TCFL system. My present doctor takes both USFHP and TCFL. Remember that USFHP is nothing more than a contract progam for TCFL.

I can use the VA, and I have used the VA. I get an annual check up including vision and hearing. I can also go in anytime I am sick or need them. All of my medications come from the VA.

My wife is a veteran but not retired or disabled. Heck at 77 she can out walk most 20 year olds. She does not want to sign up as a veteran, even though she could. She uses USFHP and Maxor Pharmacy under that program. She would be the one that I would have to use the TCFL, and me occasionally.

Her, and my, present USFHP system does cover annual eye exams, and yes all surgical portions of any eye problems. I just checked today and her annual vision check up would be $59, so once a year at $59 is a lot of a heck cheaper than FEDVIP at $20 or $25 monthl, depending on program. Same with dental. She has had to pay around $250 for her dental check-up, but the dentist I go to gives military and seniors a big discount. A first time appointment to include xrays, exam, and cleaning is $89.

No glasses are not covered for her and I get mine from the VA Optical. DW gets her's from VA Optical. Full price for progressive, glare proof, transition is about $219.

Life goes on but I'm still interested in hearing from TCFL member that travel between regions.


Ray, my ophthalmologist's office today said that TCFL will not cover eye exams. Maybe I should go to your doctor. :-)



Steve, see what I'm going through? You say they do not cover eye exams, and Ray said they do. I've communicated with Ray for a while on two forums so I'm not going to believe him.

I have been all over the TCFL web site. Not very intuitive but doable. One time I did read the page about authorization if traveling to a different region. Guess I'm going to have to call TCFL and ask to speak to a supervisor.

[Lv2Roam2]

Hang in there - the SOPs for these programs are confusing - made more so by the turn of just a word or two sometimes, e.g., routine. Glad you and better-half have VA coverage.

[Ray,IN]

[QUOTE=.


Ray, my ophthalmologist's office today said that TCFL will not cover eye exams. Maybe I should go to your doctor. :-)



.[/QUOTE]
Perhaps I didn't write what I was thinking; Medicare pays for eye exams, DW just had her annual today, the receptionist just said goodbye and we came home.
Re-reading my reply, I did state it correctly, however my writing and sentence skills have diminished over the years, and I mentioned the TRICARE so it might be read as paying for any eye exam difference(which it does NOT). I apologize for any confusion.