Private-sector physicians increasingly are refusing to care for military retirees and family members because of erosion of payment rates, some military beneficiary groups argue.
Defense Department officials said, however, that such cases are not widespread and that the expansion of the military's Tricare regional managed-care program can solve the access question.
The Defense Department appropriations legislation in 1993 required that physician reimbursement under the Civilian Health and Medical Program of the Uniformed Services, or CHAMPUS, match Medicare physician fees, which typically had been lower than the CHAMPUS rates.
Any reduction was limited to 15% a year. Today, payments for about 85% of CHAMPUS procedural codes match the Medicare physician fee schedule.
The law also placed limits on balance-billing of CHAMPUS beneficiaries. Total physician charges are limited to 115% of the CHAMPUS maximum allowable charges, making beneficiaries liable for any charge beyond the CHAMPUS rate.
Originally intended as a backup for retirees and military family members who couldn't see doctors at military hospitals, CHAMPUS is being relied on more and more by those beneficiaries as the Defense Department streamlines its medical corps as part of an overall armed forces reduction.
But with payment rates going down, some beneficiary groups-particularly the National Military Family Association-contend that finding a private-sector doctor who will accept CHAMPUS patients is becoming more difficult.
"Military families are being left out in the cold," said Daniel Moll, senior policy director for the House Government Reform and Oversight civil service subcommittee. "The problem with CHAMPUS is it's characterized by high and unpredictable out-of-pocket costs."
Beneficiary groups disagree, however, over whether the problem is widespread.
Although CHAMPUS rates will equal Medicare rates, beneficiary groups say doctors are less willing to care for CHAMPUS beneficiaries because they are less likely than Medicare beneficiaries to become permanent patients, and they typically are younger patients who will visit doctors less frequently.
In one area, Dothan, Ala., near Fort Rucker, the Pentagon has made an exemption to its reimbursement policy and paid obstetricians and gynecologists more than CHAMPUS rates.
But Defense Department officials said the problem is not widespread.
Furthermore, they say that whatever problems now exist will be solved when the military sets up networks of physicians working under Tricare managed-care contracts, which are scheduled to cover the entire country by mid-1997.