Returning soldiers struggle to find therapistsMon Jun 11, 2007 02:57
Returning soldiers struggle to find therapists
Waiting lists grow as military trims payments for mental-health care
Dr. Barbara Romberg, executive director of 'Give an Hour,' provides free counseling for veterans and their families. The military's insurance plan is paying less money for soldiers to see a therapist or psychiatrist at a time when more of them need help coping with the psychological effects of war.
Updated: 11:36 a.m. MT June 10, 2007
WASHINGTON - Soldiers returning from war are finding it more difficult to get mental health treatment because military insurance is cutting payments to therapists, on top of already low reimbursement rates and a tangle of red tape.
Wait lists now extend for months to see a military doctor and it can takes weeks to find a private therapist willing to take on members of the military. The challenge appears great in rural areas, where many National Guard and Reserve troops and their families live.
To avoid the hassles of Tricare, the military health insurance program, one frustrated therapist opted to provide an hour of therapy time a week to Iraq and Afghanistan veterans for free. Barbara Romberg, a clinical psychologist in the Washington, D.C., area, has started a group that encourages other therapists to do the same.
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“They’re not going to pay me much in terms of my regular rate anyway,” Romberg said. “So I’m actually feeling positive that I’ve given, rather than feeling frustrated for what I’m going through to get payment.”
Joyce Lindsey, 46, of Troutdale, Ore., sought grief counseling after her husband died in Afghanistan last December. The therapist recommended by her physician would not take Tricare. Lindsey eventually found one on a provider list, but the process took two months.
“It was kind of frustrating,” Lindsey said. “I thought, ‘Am I ever going to find someone to take this?”’
Roughly one-third of returning soldiers seek out mental health counseling in their first year home. They are among the 9.1 million people covered by Tricare, a number that grew by more than 1 million since 2001.
Fragmented, inadequate benefits
Tricare’s psychological health benefit is “hindered by fragmented rules and policies, inadequate oversight and insufficient reimbursement,” the Defense Department’s mental health task force said last month after reviewing the military’s psychological care system.
The Tricare office that serves Fort Campbell, Ky., and Fort Bragg, N.C. — Army posts with heavy war deployments — told task force members that it routinely fields complaints about the difficulty in locating mental health specialists who accept Tricare.
“Unfortunately, in some of our communities ... we are maxed out on the available providers,” said Lois Krysa, the office’s quality manager. “In other areas, the providers just are not willing to sign up to take Tricare assignment, and that is a problem.”
Tricare’s reimbursement rate is tied to Medicare’s, which pays less than civilian employer insurance. The rate for mental health care services fell by 6.4 percent this year as part of an adjustment in reimbursements to certain specialties.
Since 2004, Tricare has sped up payments to encourage more doctors to participate, said Austin Camacho, a Tricare spokesman. In some locations, such as Idaho and Alaska, the Defense Department has also raised rates to attract physicians, he said.
“We are working hard to overcome those challenges,” Camacho said.
Jack Wagoner is a retired military officer and psychologist and psychiatrist in private practice who also works for a Tricare contractor. He told defense mental health board members last December that in general, Tricare pays “considerably lower” than private health insurance plans.
According to data from Tricare’s Medical Benefits and Reimbursement System office, Tricare pays mental health providers as much or more than a corporate plan would pay a therapist for treating a patient — although in some cases it is lower.
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There are different coverage plans within Tricare, and the amount paid to providers varies by plan, location, specialty and services performed.
Psychologists who treat active duty troops are paid 66 percent of what Tricare views as the customary rate. So a psychologist eligible for a customary rate of $120 per hour would be paid $79.20 for the hour by Tricare, even if the psychologist’s standard rate is $150 per hour.
Active duty troops use Tricare Prime, a managed-care option maintained by private contractors. Their mental health care is free. Guard and Reserve troops and their families frequently use Tricare Standard, a fee-for-service plan. They pay an annual deductible and 20 percent of the amount Tricare pays the therapist.
John Class, a retired Navy health care administrator who now advocates on health issues for the Military Officers Association of America, said Tricare Prime contractors insist that the lower reimbursement rates has made it tougher to maintain a network of providers.
‘Starting to see the pinch’
“We are already starting to see the pinch,” Class said.
In a limited study by Tricare released earlier this year, about two out of three civilian psychiatrists in 20 states were willing to accept Tricare Standard clients among their new patients, the lowest acceptance rate for any specialty.
Any additional cuts in Tricare payouts could mean that “some really good psychologists who specialize in this treatment and are experienced will be seeing less of (military families),” said clinical psychologist Marion Frank, a widow who is president of the Philadelphia Chapter of the Gold Star Wives of America, a support group for military widows.
In parts of Montana, some families drive two hours to see a physician of any kind that will take Tricare, said Dorrie Hagan, state family program director for the Montana National Guard.
“When you get away from a city of any size then you start struggling for providers, and they’ll tell you flat out it’s because of the rate of pay,” Hagan said.
© 2007 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
The Israeli Attack on the USS Liberty
Would the US allow its citizens to be attacked and killed by a foreign power and then cover up the facts?
It would - and it has.
On June 8th, 1967, the Israeli military attacked and attempted to sink the USS Liberty as she sailed under a US flag in international waters. Thirty-four US servicemen were killed and 171 injured by a well-coordinated, multi-wave assault which included the use of napalm.
The Israeli military called the attack a "tragic mistake" and then-President Lyndon Johnson agreed it was nothing more. Sailors who were aboard the ship were warned not to disclose the facts of what happened that day under penalty of court martial - or worse.'
Insider Tells the Truth About the Cover-up of the Attack on the USS Liberty
'Son, I spent 2 years as a special agent in the FBI and over 30 yrs in the military, and if it is one thing I learned through all of this, it’s that when you get an order, you say ‘yes sir’ and carry it out with no questions asked’.
In 2002, Capt. Ward broke his silence of 3 decades and released an affidavit to the public in which he admitted that the entire investigation was a sham, and that he was under orders (from persons of no less authority than President Lyndon Johnson and Secretary of Defense Robert McNamara) to rule that the bloodiest day in American naval history since WWII took place as a result of ‘mistaken identity’ and that America’s ally, Israel–was innocent of any wrongdoing.
'A conflux of events however led him to make the decision to ‘damn the torpedoes’ and to let the chips fall where they may. ‘I’m an old man’ he told AFP. ‘They can’t threaten my job, and if they throw me into jail, so what? The truth has to be told for the benefit of the survivors and for the American people whose sons and daughters are dying today’.
The first of these events leading him to break his silence was the 2002 release of a book entitled ‘The Liberty Incident’ written by Judge Ahron Jay Cristol at a time when America was being drawn into a series of long-term military engagements with countries that just so happened to be enemies of Israel. Through his book and subsequent speaking tour, Cristol (a slavish, shameless, fanatical apologist for the Jewish State who is on more-than-friendly terms with a number of people in both the military and arms industry in Israel) did the usual song and dance when it comes to discussing the terrorist state that attacked America in 1967, which was to argue for unconditional acquittal, using a collage of sloppy yet deliberate misrepresentations and omissions of fact. In Capt. Boston’s words, it was Cristol’s ‘insidious attempt to whitewash the event that pushed me to speak out’.
‘These rats,’ he said, referring to Israel and her defenders. ‘They lie about everything. You can’t believe a word they say’ he told AFP. What was so important about this statement was that Capt. Boston was not just talking about the past, but about the present and future as well. ‘They’ve completely infested the entire Intelligence and Defense apparatus of the United States’ he said. ‘Perle, Feith, Wolfowitz, and all the rest of them…They’re spies for Israel, every damned one of them’ he said. ‘Just consider the 5 guys who were arrested after 9/11, cheering and celebrating, and then afterwards we come to find out that they were Mossad and then they get sent back to Israel. They knew all about it and yet our government, the government I worked for most of my life did nothing about it. Can you imagine if these guys were Arabs?’ he asked. ‘It’s been the same thing, ever since 1967’ he said with unmistakable aggravation. ‘Protect Israel, protect Israel…In the meantime, our boys are dying over there and those who don’t die are coming back here with all sorts of problems, both physical and psychological’.
It was his visit to Israel some years back that clinched it for this man in terms of his feelings for the ‘great experiment’ in Jewish self-rule. ‘The way they treat the Arabs…it’s unconscionable’ he said. ‘You go into Israel, into the only places where they allow the tourists, and it’s the picture of paradise, just as the Soviets used to do. Then you take a detour off the approved itinerary and you see what it is really like…The poverty, misery, abuse. Arab kids being gunned down in broad daylight. It’s worse than South Africa. Only a person with a ice water in his veins could see the way the Arabs are treated and not be outraged’.
As far as the future goes, Capt. Boston is not hopeful. ‘If either they (the Israelis) or the US launches a war against Iran, it will be the beginning of the end’ he said. ‘Armageddon…You’ll have Muslims pouring into the area from all over the world and no army will be able to stop them. They will tear Israel and the Americans to pieces.’
As far as his reaction to the predictable accusations of ‘anti-Semitism’ that have been leveled against him for telling the truth concerning the attack on the Liberty, he laughs it off. ‘One of my closest friends growing up was Jewish’ he said. ‘I don’t have a prejudiced bone in my body. What we are dealing with here is an act of war initiated against the United States, the country I swore an oath to defend, period. If a proper investigation into the attack on the Liberty had been allowed to take place and the American people made aware of what happened, we would not be in the middle of this mess in the Middle East now.’
2007 By Mark Glenn'
See comment on next story down.
Israel's Attack on the USS Liberty, Revisited
As the Liberty listed in the choppy seas, its deck aflame, crew members dropped life rafts into the water and prepared to scuttle the ship. Given the number of wounded, this was going to be a dangerous operation. But it soon proved impossible, as the Israeli attack boats strafed the rafts with machine gun fire. No body was going to get out alive that way.
That's par for the course. But something else was going on that would only come to light later. Through most of the 1960s, the US congress had imposed a ban on the sale of arms to both Israel and Jordan. But at the time of the Liberty attack, the Pentagon (and its allies in the White House and on the Hill) was seeking to have this proscription overturned. The top brass certainly knew that any evidence of a deliberate attack on a US Navy ship by the IDF would scuttle their plans. So they hushed it up.
In January 1968, the arms embargo on Israel was lifted and the sale of American weapons began to flow. By 1971, Israel was buying $600 million of American-made weapons a year. Two years later the purchases topped $3 billion. Almost overnight, Israel had become the largest buyer of US-made arms and aircraft.
Perversely, then, the IDF's strike on the Liberty served to weld the US and Israel together, in a kind of political and military embrace. Now, every time the IDF attacks defenseless villages in Gaza and the West Bank with F-16s and Apache helicopters, the Palestinians quite rightly see the bloody assaults as a joint operation, with the Pentagon as a hidden partner.
Thus, does the legacy of Liberty live on, one raid after another.
Ron Paul : Stop Dreaming
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