Backstory: You are a united states civil service federal employee (say that three times fast) working for the military outside of the continental U.S. It's time to go see a doctor. What do you do?
Well, here's what I know and have learned so far from my experience. And, being employed by BUMED (Navy Medical), I have a little bit of inside knowledge.
In a prior post I talked about my experience and tried to explain the system a little bit. Since then, the new Defense Health Agency (DHA), which is a consolidation of health care services for the defense community across different branches, has started their take-over of healthcare where I live and work in Japan. There have been some bumps along the road.
Current Day: The essentials are that military medical treatment facilities (MTFs) prioritize who they treat. 1 - Active Duty. 2 - The dependents of active duty. 3 - Retirees and others who have TriCare medical insurance. 4 - Civil service, federal employees w/out TriCare. They do not treat contractors.
The biggest thing to keep in mind is that military medical is very, severely, like don't act surprised when you get here, LIMITED. The clinics have basic, no specialty care. The hospital has most specialty care but not all and also not all of the time. Doctors are military and they change duty stations which gaps positions. And oh ya, the US's medical staff shortage exists here, too. Which means that care has to be outsourced to the surrounding community.
My biggest suggestion for all civilians w/out TriCare - plan from the beginning to get your medical needs met out in town. I cannot stress this enough.
But back to military medical care. If you need to be seen, as of the writing of this, you can be seen in an MTF for care of your chronic conditions if you are not a contractor, if you are a federal employee, and if you don't have TriCare. You will be seen on a space available basis, no appointments. If you are referred out into town you can go through the clinics' partnership of medical facilities and use the clinic's translators. There is a phone number you can call to get a translator at will on the phone - but that service exists on paper more than it does in real life.
Cynical alert - I believe there is translation services company out there taking DoD contractor money, putting it towards CEO bonuses and shareholder profits, and then not providing the actual service. How do you get away with this? By buying a congressperson (R) or ten.
Back on track. Once you get billed, you get billed what TriCare would be billed. Since TriCare is military medical healthcare, they get charged the most expensive rates out there. And when you have to pay for your care out of pocket, that is a shit-ton of money. Think about it. US healthcare prices are hundreds of percent higher than any other developed nation. Then getting charged the highest rates of that system. Ya, if you go through on base MTFs, and you have to pay out of pocket, you are getting SCREWED.
You pay your bill in full out of pocket then submit a reimbursement claim to your personal health insurance. And good luck getting them to pay you what you paid for your care.
Right now, we are all waiting to see what Congress with order DHA to do in regard to mandating or not care for civilians. Even if Congress requires on-base MTFs to see civilians for all of their healthcare needs, there are not enough resources to meet that need. MTFs are STRUGGULING with aging buildings and gapped positions to meet just the needs of the Active Duty, which is their prime mission.
Moral of the story - think long and hard about coming overseas if you have complex or special medial needs, if you have reservations about using host nation healthcare and translators, or if you just think that you can show up at the on-base clinic to get whatever care you want.
Aside: This post has a lot of frustration in it because that is life right now over here. This whole situation with DHA, the rules changing, the back lash, the expectation to do more than can physically be provided - it's a lot.
Finally - how much of this did I know before I took this job. Zero. Did I do any research? Hard YES. The fact is this is not a topic that has a lot of resources to cover it. Human Resources doesn't talk about it. They just set you up with the website to pick out your employee health insurance plan. Do civilians talk to each other? Ya, but that convo doesn't go past the immediate group. So, if you need more info, tell me what you need, and I will do what I can to answer your questions.
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