Medical Care Overseas

Medical Care Overseas

Let me share what I have learned about getting medical care while working as a US civilian in a foreign area. The short of it is that I go off base and find a healthcare provider, get seen, pay out of pocket, submit paperwork to my private insurance, then get reimbursed if they approve the claim.

The long of it is, well, long. Get comfy.

Some background info to set the stage. Private insurance in this post is referring to a U.S. based company that is most likely purchased through your job. TriCare is military health insurance which covers active duty, their dependents, and retirees. A dependent is someone dependent upon the active duty service member such as child, spouse, or parent if the service member is their primary caregiver. A retieree is someone who spent at least 20 yrs in the service and has retired. One of the retirement benefits is TriCare for life.

Now some context: You’re a civil service employee, maybe working under GS, maybe NAF, based on a US military installation outside of the U.S. You don’t have TriCare but you do have private insurance, most likely through your job. With me? Good.

The way healthcare on base is structured is that there is a main hospital on a large base or in a central location. In mainland Japan that in on Yokosuka. Each installation (camp, base, yard, etc.) has some kind of medical facility on it from clinic to detachment. The smaller the base, the smaller the onbase healthcare facility will be and the more limited the services will be.

In order to meet the medical needs of the base population there are agreements between out-in-town (the term used for anything off base and past the guard gate) medical facilities and the base’s medical center. The clinic makes a referral to a provider out in town, the Host Nation Coordinators sets up the appointments, provides translation services, and takes care of the paperwork.

So the flow can be to see a provider in the base healthcare facility, probably get a referral out in town, work with Host Nation Coordinators for the referral appointment, come back to the base health care facility for the follow-up. Rinse and repeat as needed.

Now, back to the civilian looking to get healthcare. There are two options, use base health care or off base health care. Being seen on base is the instinctual go-to but actually worst option because:

1. You can’t make an appointment. Appointments are for Active Duty and their dependents. Retirees and Civilians are seen on a space available, or Space-A, basis. You show up at the beginning of the day, check in at the front desk, and then wait for an opening.

2. You're going to be referred out into town anyways since services are so limited. Unless you're going to the hospital which has the full coverage of services.

3. Military medical billing does not take private insurance but they can kind of help you out with the paperwork. You can either pay military medical in full and submit your claim yourself. Or have them submit the bill for you which might sound nice on the surface but for me, that just leaves me calling military billing and my insurance company trying to find out if the mountain of paperwork was properly transmitted and if not, what has gotten lost and where is it?

4. You're going to be charged for your visit U.S. prices.

So you skip all of that and go directly out into town. Now, you do want to make one stop before heading out at the TriCare office or the Host Nation Coordinators office. I found that those two offices had compiled a list of English speaking or English translator available providers which made my life a hell of a lot easier.

I found an international hospital near where I live that provides a translator throughout the whole visit. I get seen, I pay out of pocket Japanese healthcare prices, then submit the claim to the insurance company.

Now let's throw in here, just for funsies, VA Overseas healthcare and Host Nation national insurance. If you are a veteran with a documented service connected disability you can be seen anywhere in the world for care of that disability and then have that be reimbursed. It's basically the same thing. Get seen, pay out of pocket, submit paperwork to the VA, get reimbursed, if they approve the claim.

For Host Nation national insurance, most nations around the world have some kind of universal healthcare such as Japan’s single payer system. A single payer system is where the government is the single payer and buys health insurance at a discount, bulk rate. Citizens are then required to pay into the system at the discounted rate. Participation is mandatory since healthcare is a service absolutely everyone will use and it is an essential part of life. The national health insurance in Japan is cheap with low out of pocket deductibles, like most countries. But as a SOFA visitor I can not participate in the tax supplemented national health insurance of any country. One of the items in the Status of Force Agreement, SOFA, is that I do not pay taxes to the country in which I am living for the duration that I am here under this SOFA visa. On the flipside, I don't participate in anything that is tax funded such as the national health insurance. So, no national insurance from the host nation for me.

And that’s it in a nutshell. Hope it helps and Cheers!!