Aug. 02--TARBORO -- The decision to not accept TRICARE Prime health insurance was not one that was made by Vidant Multispecialty Clinic, according to Vidant officials.
Vidant Multispecialty, formerly the Tarboro Clinic, would have accepted all three levels of TRICARE coverage except for the fact that Health Net Federal Services, TRICARE's plan administrator, chose not to countersign an agreement that would have facilitated the continuation of the coverage at the clinic.
As a result, according to Bill Hayes, Vidant Health's Director of Managed Care, the clinic stopped accepting TRICARE Prime effective June 30.
It is a decision that doesn't sit well with local veterans, some of whom blamed Vidant for not accepting the coverage.
The clinic still accepts TRICARE Standard and TRICARE for Life health insurance plans. Unlike TRICARE Prime, TRICARE Standard does not require an agreement with Health Net Federal Services and is accepted at all healthcare facilities that accept Medicare, Hayes said. TRICARE for Life, the secondary insurance coverage for Medicare Parts A and B, also does not require a network agreement.
"TRICARE Standard may be the best choice if a provider is not contracted in TRICARE Prime network and enrollees don't want to change providers," Hayes said in a written statement. "TRICARE Prime has less freedom of choice for providers as enrollees must utilize a Military Treatment Facility, TRICARE Service Center (clinic), or select a provider from a limited provider network."
The majority of TRICARE beneficiaries in the Vidant service area are enrolled in TRICARE Standard because of the network limitations of the TRICARE Prime plan, Hayes said. TRICARE Prime patients who do not wish to change their insurance have the option of asking for an exemption from Health Net Federal Services in order to continue receiving care from their primary care physician or discussing their plan options.
Air Force veteran Steve Alderman said he was told Vidant chose to end the contract with TRICARE Prime because of "recent legislation" -- the Patient Protection and Affordable Care Act (PPACA), known informally as Obamacare. Austin Camacho, chief of benefit information and outreach branch for TRICARE management activity, responded with the following statement:
"Neither the passage of the PPACA nor the recent Supreme Court ruling upholding the PPACA had a direct impact on the TRICARE benefit, or TRICARE's commitment to provide the best possible health care to its more than 9.7 million beneficiaries."
Camacho went on to state that TRICARE is under the sole authority of the Defense Department and the Secretary of Defense and that service providers chose to join or leave the TRICARE network for "a number of possible reasons."
Although Vidant Multispecialty Clinic no longer participates with TRICARE Prime, Edgecombe County still has a couple of participating providers with TRICARE Prime, including Vidant Edgecombe Hospital and Dr. Emma Castillo at Tarboro Internal Medicine. A spokesperson at Tarboro Internal Medicine said Castillo has had a recent increase in new patient requests and is currently accepting new patients.
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