It's taking too long to get urgent care except by visiting the hospital?

My son is stuck with Tricare Prime via his dad's choice of health insurance coverage.  He had his first grand mal seizure and was released from the hospital 24 hours later with very little direction or advice.  .  The refering clerk tries but didn't understand "urgent" because my son's psychiatrist said ASAP.  Two days later, she refers us back to the ER neurologist whos office tells me that he and all of his assoicates are on vacation for a month.

.I make the effort to call every neurolgist on the HMO's preferred physician's list only to find most of them are not neurolgoists but Neurology DOs, EEG Neurofeedback docs, or Sleep medicine doc.  None of the neurologists would call back after leaving a message though I did find one out of network doc willing to take my son two weeks from now.  I just got a message from the refering clerk who is now trying to refer me to a doc who already told me not accepting Tricare patients and she will check up on it on Monday.  We are now two weeks into this process of needing a neurologist immediately to give medical management advice.

The insurance rep asked me to disenroll my son from Tricare Prime and 24 hours later, my son will have Standard Tricare immediately and we do not need to go through the PCM.  He will have all the same benefits .... it will just cost us 5% more.  This sounds very suspicious.  I don't have Tricare for myself but I do know my insurance will make me wait a short period before paying for some benefits.

I really don't know what to do.... he just turned 18 and wondered if there is any other type of insurance out there for 18 yr olds who do not have a job and has enrolled in college to start in the fall.

[Amir Mostafaie]

Dear justTess,

Health Insurance laws are still very state specific and I could not tell from your post or your profile, where you live, but one provision of the new law protects children up to the age of 18 by not allowing insurers to decline them due to pre-existing conditions. It sounds like that provision doesn't apply to your son as he just turned 18.

Another provision allows parents to keep the child on their plan uptill the child turns 26. This provision does apply to your son; so if your group coverage is better than Tricare, you may want to check with your Humana Resources to see what it would cost you to switch his coverage to your group plan. If that option turns to be cost prohibitive, you will need to explore the option of switching his coverage to Tricare Prime, however I do not recommend doing so until you call the customer service and ask to speak with a supervisor to clarify what exactly you need to do and if there are risks in doing that whatsoever; and I mean above and beyond the 5% extra charge. When you speak to the supervisor, make sure to document their first/last name, title and the phone you got connected and everything they tell you.

It is important to get your son on the appropriate treatment before he has another seizure.

Sincerely,

Amir Mostafaie