WASHINGTON — Across America, soldiers, veterans and their families are running into red tape and roadblocks when they try to use their military insurance to get treatment for ailments such as post traumatic stress disorder.
Since 2003, some 40,000 troops have been diagnosed with PTSD. The number of cases rose by roughly 50 percent in 2007, according to Pentagon statistics released Tuesday.
The deployment of hundreds of doctors and therapists to Iraq and Afghanistan and the shortage of military health care providers has forced patients at U.S. installations to wait for months for appointments — and longer if they need to see a specialist, according to advocacy groups for members of the military and their families.
Meanwhile, civilian doctors and psychiatrists say they're often faced with tough decisions about whether to turn away patients on Tricare, the Defense Department program that insures 9.2 million current and former service members and their dependents, because its reimbursement rates are low and its claims process is cumbersome.
Others volunteer their time and services rather than navigate Tricare's red tape for what may ultimately prove to be a small reimbursement for services.
"We do have a lot of doctors who are seeing Tricare patients almost on a pro bono basis because they care and for the love of their country. But it's easier to do that if it's a dozen patients than if there are 100 patients," said Steve Strobridge, the director of government relations at Military Officers Association of America.
Tricare's reimbursement rate are linked to Medicare levels. Health care providers who treat patients on both programs will take a 10 percent pay cut on July 1 and a second, 5 percent, pay cut on Jan. 1, 2009.
"We want to do our patriotic part and take care of our military population. I've already frozen my Medicare population, and I'm about to freeze my Tricare population," said Dr. Mitchell Miller of Virginia Beach, Va., who sees patients from a number of the area's military installations. "It doesn't sit well with me to have to turn away people who have served our country, but it's an economic reality. It's an American tragedy, really."
While physicians such as Miller will continue to see current patients on Tricare, many others are refusing to accept new patients.
The Department of Defense has long been aware of both the physician shortage and patient and provider complaints about Tricare.
During a recent American Psychiatric Association annual meeting in Washington, Col. Elspeth C. Ritchie, a psychiatry consultant to the Army's surgeon general, pleaded with mental health care providers to consider joining the military or at least accepting Tricare.
"We're having a hard time trying to recruit psychiatrists," Ritchie said.
Last year, a Pentagon mental health task force found that a Tricare office near Fort Campbell, Ky., the home of the Army's 101st Airborne Division, often gets complaints from patients who have a hard time finding therapists who accept Tricare.
Over nearly a decade, the Government Accountability Office has issued several reports critical of Tricare's ability to process reimbursement claims, address patient complaints and identify when there aren't enough civilian providers.
The problem is especially acute in rural areas.
While the Tricare reimbursement rates are linked to the Medicare levels and vary depending on the health service provided, the Department of Defense often pays more to providers where "service is seriously impaired," such as Alaska and parts of Idaho.
"We want to assure that Tricare payment rates are sufficient to avoid impaired access for Tricare beneficiaries, but this must be balanced against the need to use limited resources wisely," said Eileen Lainez, a Pentagon spokeswoman.
During a visit to Alaska Sunday with Sen. Ted Stevens, R-Alaska, however, veteran's affairs secretary James Peake suggested that some of the concern about PTSD and traumatic brain injury has been overblown. Many of the brain injuries are serious, he said, but some of them are akin to what anyone who played football in their youth might have suffered, according to a report in the Anchorage Daily News.
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