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TRICARE The Military Health Plan

TRICAREBy Major Yvonne Altenderfer, Retired

Editor’s Note: It started with an email from my friend Yvonne.

I saw the knee doctor today.  He took an x-ray of the left knee.  The inside part of the knee joint has no cartilage/cushion.  He recommended a partial knee replacement.  I asked about a full knee replacement and he said it would be better at this time to do a partial (I'm too young...) Glad to hear a partial is better at this time.  The outside of the knee cap has plenty of space and cushion.

He gave me a cortisone shot for the pain, and I'll go back in three weeks.  We will probably schedule surgery for the third week in January.  He also said the partial knee replacement had a shorter recovery time—three weeks. 

I asked her about her problems with her knee, because I have a really bad knee and the cartilage has been disintegrating since I was in my 30s. However, I don't have any problems unless I exercise on it wrong and don't wear the proper shoes or a knee brace. I also asked her if she was going through IMSS.

Yvonne replied:

It is like the point of the knee joint keeps coming out or joint when I walk and I hear a thunk and feel it.  (Bone on bone)  When I'm just sitting around, it aches.  At night it hurts so much I can't lay in a comfortable position.  When I walk…when it thunks…I get a sharp pain.  Even when I'm horseback riding and put a little pressure on my horse's side to get him to turn, it hurts from the pressure.  Sometimes it hurts just to touch it!  Then there are other times that it doesn't hurt at all, but those times are getting further and further apart. 

It is time.........  I never WAS one to deal with sickness and pain.  Give me something for it or do something.......

I tried wearing a knee brace and my leg swelled up above and below the brace.....go figure!  Now I just wear it when I go to town and it does help a little.  

No, I don't have IMSS.  I am a retired Air Force major and have TRICARE so my military insurance will pay for most of it.  I'm on the overseas coverage so there are hospitals here that can file for the claim and get paid.  I have a $3000 deductible.  But I have confidence with this doctor and don't want to go through the hassle of finding one in the United States.

He said the surgery would be around $9000-11000US.  

I have been having Synvisc injections in the knee joints and they have really helped for the past two years.  If you have pain, you might try that.  This doctor, Dr. Gonzales, is painless!!!!!!!   VERY important to me. 

(For those of us who are clueless, Synvisc is an injectable treatment used for knee arthritis. Often called a 'joint lubrication,' Synvisc is typically administered as a series of three injections into the knee joint, each injection spaced about one week apart. Synvisc has been shown to help alleviate arthritis symptoms for 6 months, and to delay the need for knee replacement surgery.)

Yvonne said since she was a retired major in the air force that she was going through TRICARE, which is the health care program serving Uniformed Service members, retirees and their families worldwide. I, of course, asked her if she would provide her experiences with TRICARE in Mexico since we’ve had this question a few times.

Yvonne updated a little while later:

Well, now that I actually have a surgery date, January 17, 2011, for partial knee replacement, I had to do more extensive research on the TRICARE.  Turns out none of the hospitals in Guadalajara accept TRICARE for payment.  I have to pay with a credit card and submit all the bills to TRICARE for reimbursement.  TRICARE wants a lot of details about what was done, including justification for the surgery.  I can either fax or mail the documents.  Turnaround time for reimbursement is about three weeks after all documentation is received.  For purposes of reimbursement, we are considered "overseas” in Mexico. Therefore, I, as the patient, pay 25% of the cost of the surgery with a limit of $3000 for each surgery plus $150 to the doctor and TRICARE picks up the rest.  

Actually I'm kind of disappointed but that is the way it is and there isn't anything I can do about it. 

TRICARE paid about 80% of my medical expenses for the partial knee replacement. They paid the first part of the bill, which was the hospital, room, meals and things related to that within three weeks.  (That was the time period they originally said it took to process the claim and pay it)  The hospital and doctor and prosthesis people all gave me a detailed print-out receipt of their bill.  So I actually had three charges.  I submitted ALL copies of receipts including a copy of the credit card statement showing the credit card charges.  I kept my original receipts on everything.  When my documentation got to TRICARE, they made copies of it.  (I just didn't want my originals to be lost in the mail).   

I made a mistake and didn't include DETAILED information about the bills. so they returned some paperwork for further information.  The question was “did I pay all my expenses with a credit card.”  I didn't, but didn't make a statement to that effect when I originally submitted my bills.  I paid for the doctor's visits post op, lab tests, X-rays and medications with cash. 

TRICARE paid all post op, medicines, hospital, doctors, prostheses.  As I said earlier, I have a $3000 annual deductible, so out of a $10,000 bill, I got reimbursed a little less than $6,000. 

They mail the check/s to the address you submit on your claim form so I received my checks through my Handy Mail Account here in Mexico.  I asked about direct deposit to my bank in Texas and was told they would not do that. 

The TRICARE that we use is TRICARE Overseas at 001-215-942-8393.  The address to submit the medical paperwork is TRICARE Overseas, PO Box 7992, Madison, WI   53707-7992.


Go to www.tricare.com.  Or www.tricare-overseas.com   There are several options to choose from. 

Phone numbers:  TRICARE overseas   215-942-8393.  Overseas, the veteran (in Mexico we are considered "overseas") pays the first 3000 for the surgery plus 150 to the doctor and TRICARE picks up the rest. 

I am sorry Yvonne had to go through all that, but I really appreciated her taking the time to write it all down for our service men and women here in the Lake Chapala area.

From: medpathgroup.com

Is it really cheaper to have knee replacement surgery abroad in Mexico?

Particularly for U.S. residents, the savings can be enormous. Especially when you take the fees and room cost involved with medical treatment out of the picture. The cost of a knee replacement surgery in the U.S. is about $45,000 in the U.S. but in Mexico, the savings can be substantial.

Is it safe to have knee surgery abroad in Mexico?

If you are concerned about the thought of being treated abroad, you needn’t be worried.

Here’s the truth about the hospitals in Mexico we work with.

  • They are internationally accredited by the JCI* and top rated
  • The doctors are board certified, meaning they have had to pass rigorous examinations and extensive training.
  • The equipment, prosthetics & technology used are of the highest standards and top quality. They are the same or better than you would get in your local hospital.
  • The hospital and clinic medical staff and doctors offer first rate quality personal care and attention that will far exceed your expectations.
  • Compared to what you will pay for the surgery locally, it is significantly less expensive.
  • A partial knee replacement procedure can be performed closer to home for those in the U.S. or Canada at a private hospital in Tijuana, Mexico. This carries the advantage of not having to go far from home to have the procedure, which is far less costly than a similar procedure done in the U.S. Patients can stay at the hospital and at five star hotels close by.

Full & Partial Knee Replacement Costs in the USA (www.ehow.com)

The cost of knee replacement surgery in the United States for the uninsured can be less than the average because of discounts given by some medical institutions. For example, the Tulane University Hospital and Clinic can have a discounted price between $29,000 and $34,000, while the Kapiolani Medical Center in Hawaii (where the full price is $33,000) can have a discounted price of $20,000 to $24,000. A partial knee replacement can cost anywhere from one-half to the same amount of a total knee replacement.

I sent the article to Yvonne and she responded:

Good article. Near the end you were quoting prices NOB as compared to here. Be sure you are clear about PARTIAL replacement costs as compared to TOTAL KNEE replacement. Partial in the US is about $21,000. I think you said total knee replacement was $45,000. Thanks for everything you are doing to help inform the gringos living Lakeside!!!  

No, thank you, Yvonne, for allowing me to publish your information! It's our subscribers who make this newsletter what it is. People helping people is what it's all about! 

* The JCI is an international accrediting body for medical facilities that has been approved by the International Society for Quality in Health Care. It also works in conjunction with the World Health Organization on issues of patient safety.

 


Karen McConnaughey: Operations Manager for FocusOnMexico.

Focus On Mexico offers 8-Day Educational Programs to Ajijic and Lake Chapala, Mexico (2nd Best Climate in the World). Join us on a Focus program and learn why thousands of Americans and Canadians chose to retire in Lake Chapala.

Our programs offer the perfect balance; a wonderful vacation and an insightful, educational experience. Our expert speakers cover all topics: Health Care, Real Estate, Legal System, Immigration, Bringing Pets, Cost of Living, US Taxes for Americans, Non-Residency for Canadians, Living on the Lakeside, Investing in Mexico, Mexican Economy and much more...

You’ll get everything you need to help you decide if Lake Chapala, Mexico is the place for you, plus have a lot of fun doing it. Retiring in Mexico couldn't be better. 



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