Why would Humana change my PCM without telling me and send me a notice of cancellation of Tricare Prime?

PO1 Rick Serviss — Wed, 03 Apr 2019 18:29:31 -0400

I got a letter from Humana Military saying that my Primary Care Manager (PCM) is over 30 minutes from where I live and I either have to change PCM or sign a waiver. I know my PCM is a 10 minute drive so I called Humana and was told my PCM and wife's is some Doctor I've never heard of that is 7 hours from where I live. Humana could not explain who changed it or how it was changed. I asked to for us to be changed back and they told me we have a restriction, I have to get a PCM at a military treatment facility which is inconvenient. Has this happened to you. How did you get it changed back to a civilian? Thank you.

Response by SFC Private RallyPoint Member made Apr 3 at 2019 8:52 PM

SFC Private RallyPoint Member — Wed, 03 Apr 2019 20:52:12 -0400

As a service member the Military will always assign you a PCM a a MTF. Your family has an option to use a civilian provider that’s in the network based upon where you are located. Are you by a Military base?

Response by SFC George Smith made Apr 4 at 2019 12:06 AM

SFC George Smith — Thu, 04 Apr 2019 00:06:12 -0400

Its The Politics Of Health Care...
Who Ever Can Get The Job Done The Cheapest… And With Things Going Thru Humana Now … things Are Not Getting Better … in The Last 10 Years I Have gone More To The VA Than Used TRICARE...

Response by PO1 John Meyer, CPC made Apr 6 at 2019 3:24 PM

PO1 John Meyer, CPC — Sat, 06 Apr 2019 15:24:49 -0400

Tricare will always try to assign you a PCM at a military treatment facility (MTF) first, even if you're not active duty anymore. The same goes for dependents. There are only two ways you can get a PCM that's not at a MTF. One is if the closest MTF is too far away. The other is if there are no available PCMs at the MTF that is closest to you. This is what happened to my wife.

When I was active duty, her PCM was at a MTF, but then left that MTF while I was still on active duty. There were no available PCMs at that MTF, so Tricare assigned her a PCM at a non-MTF; I retired not long after that. After a while, she had a falling out with that PCM and wanted to change PCMs. Tricare sent her back to the MTF because there was an opening. When we asked why she was being sent back to the MTF because she still wanted to have a PCM at a non-MTF, this is what they told us.

It's all about "cost effectiveness". Tricare saves a good deal of money by using PCMs at MTFs. This is why I now have Tricare Select. Sure, I pay more in premiums and co-pays, but not having to deal with what you’re having to deal with is worth it.