TRICARE for PTSD: What military insurance does, does not cover

A diagnosis of Post Traumatic Stress Disorder (PTSD) can be life-altering. Though the condition has been around for years - it used to be called traumatic neurosis or "shell shock," the spotlight has increased of late due to increased diagnoses in servicemembers returning from combat in Iraq and Afghanistan.
The Diagnostic and Statistical Manual (DSM) IV definition of PTSD includes exposure to a traumatic event in which one "experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury," which elicited feelings of "intense fear, helplessness or horror," and which is "persistently reexperienced," causing "clinically significant distress or impairment in social, occupational or other important areas of functioning."

Though most see PTSD as a servicemember issue, it can affect anyone. Traumas include not only combat, but also sexual molestation and rape, surviving a natural disaster, physical abuse and more.
Some symptoms include disturbing thoughts and images about the event, avoidance of thinking or talking about the trauma, feelings of detachment and numbness, difficulty sleeping and concentrating and outbursts of anger.

Common PTSD treatments include cognitive behavioral therapy, exposure therapy, Eye Movement Desensitization and Reprocessing (EMDR) and medication, according to the Department of Veterans Affairs PTSD website (www.ptsd.va.gov).

If diagnosed with PTSD while on active duty, servicemembers should receive treatment at their Military Treatment Facility (MTF), such as Madigan Army Medical Center. Likewise, active-duty family members diagnosed with PTSD may, depending on their Tricare plan, be seen at an MTF. With 240 providers, the Madigan Army Medical Center Behavioral Health Care unit is the biggest in the Army and offers walk-in clinics for both active-duty servicemembers and families.

However, once they retire (including medical retirement, which is the case with some suffering from PTSD) servicemembers may choose to enroll in TRICARE Prime and pay the annual enrollment fee. They may or may not be able to continue care at the MTF. Retirees with a disability rating may also choose to use Department of Veterans Affairs facilities.

Servicemembers who separate without retiring but have a service-connected disability are eligible to use their veteran's benefits at VA facilities, but are not eligible for TRICARE benefits. Tricare covers a wide range of treatments for PTSD under its Behavioral Health Care Services. Outpatient psychotherapy; psychological and neurological testing; electroconvulsive therapy (ECT); and medication management as well as acute inpatient care; residential treatment; inpatient rehabilitation and detoxification; and outpatient substance use disorder rehabilitation are covered. According to TRICARE's Behavioral Health Care Services guide, beneficiaries may self-refer to a behavioral health care provider for the first eight sessions without prior authorization.

TRICARE does not cover aversion therapy (including electric shock), biofeedback for psychosomatic conditions, experimental procedures, guided imagery, psychosurgery, sexual dysfunction therapy and more. Recently, TRICARE began authorizing treatment for EMDR, a treatment for PTSD that involves focusing on stimuli such as eye movements, hand taps and sounds while talking or thinking about traumatic memories.

TRICARE Management Activities, not TriWest (which administers TRICARE benefits in our area) makes the decisions regarding what is and is not covered, said Kristi Reeve, Hub Clinical Director, Northwest Operations for TriWest.

TriWest has Behavioral Health Care Case Managers to assist beneficiaries with finding the help they need. Call (866) 651-4970. For more information about what services for PTSD are covered by Tricare, visit www.Triwest.com or call (888) 874-9378. TriWest also operates a Behavioral Health Crisis Line 24/7 at (866) 284-3743

By Melanie Casey