How To Access Therapy Services with Tricare Military Insurance

Serving in the military is something my husband has always dreamed of doing, his love for his country is amazing. His service is something that my children and I are very proud of but it has not come without sacrifice. Many sacrifices come to mind when I think about where the Air Force has taken us in the past eleven years, but today I want to help you find some support within those sacrifices when raising a child with autism.  

When my husband and I were first married and moved to our first assignment location the word “Tricare” didn’t mean too much to me and I couldn’t have told you more than a few things about our insurance or what was covered.  Today, I could write a book about my Love/Hate relationship with them.  I have a few “suggestions” for those of you who are enrolled in Tricare Standard and are having a hard time with claims/coverage, or referrals. You should keep in mind that I am not an expert and my information comes from my own experiences and endless hours of researching, calling, holding, and sometimes speaking with a representative. 

Currently, we have Jaxon enrolled in Tricare Standard; this allows him to see any Speech, Occupational, and Physical Therapist we chose. The therapist does not need to be “in network” BUT having a therapist who bills Tricare directly makes your life A LOT easier! Our current therapist does not deal with insurance companies so I pay in advance for therapy and then I file a Tricare Reimbursement form every month. This process is not fun; it is time consuming, and frustrating.  Occasionally I am reimbursed within three weeks (just in time to pay for the next month), but most of the time, like right now, I am still waiting for reimbursement dating back to February. There have been times when all I need to do is resubmit because whoever processed the paperwork overlooked something, and there are times, like right now, when they are requesting a progress report, new invoices, a current script from the medical doctor, and a copy of Jaxon’s IEP. The first time I received this request in the mail I almost panicked, I thought that his services would be cancelled and I would never get back the thousands of dollars I had already spent, but eventually, after sending every single thing they wanted, I got reimbursed.  

In my opinion, the key to getting what you need from Tricare is patience, persistence, and a little more patience. I know from experience that getting therapy for your child is possible and covered.  Sometimes you just have to keep fighting with them until they realize that you aren’t going to give up (isn’t that what advocating for your child is all about). If you have any questions about your Tricare Standard coverage you should look over your Tricare handbook or call your local Tricare office. However, remember this… you know someone (me) who is enrolled in Tricare Standard and has a child diagnosed with autism and receives Speech Therapy and Occupational Therapy twice a week and gets reimbursed for it (our therapist charges $50 per half hour) so keep fighting and email me if you have questions.  

Without speech and occupational Therapy Jaxon’s recovery would not be what it is today. We combined biomedical treatment with therapy services to achieve optimal results. It is my opinion that for quite some time to come, Jaxon will require both Speech and Occupational Therapy, and will always need some form of supplementation, (especially with the food industry, environment, and lifestyles the way they are now) but his success is proof that anything is possible if you chose a journey and stick to it.

Just remember these “key” items that Tricare Standard requires in order to cover Therapy services for a child with autism…

*Current IEP

*Prescription from Medical Doctor

*Progress Report from Therapist

*Invoices (for reimbursement) With the Diagnosis Code Matching the Progress Report.

My name is Dr. Jill Tschikof. I am the mother of two, and a military spouse. We have had struggles and successes raising a child with autism while serving in the military and I hope that my future stories will act as a form of guidance for others navigating this same path. You can find my personal blog at www.autismdeal.com, I hope that you will email me if you have any questions.

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