Ahca Transfer Discharge: Fill & Download for Free

The wealth gap is wide in the US for basically the same reasons as every other country in every other time with the same problem—the wealthy controls the access to capital.Here in the US, we have a form of representative democracy that lends itself well to being easily usurped by a few rich and powerful people. While each citizen nominally has an equal voting right to choose who is in power to control access to capital, we found that once again a few hundred chosen “delegates” or agents of the wealthy have made the final decision in the choice for the presidency. Apparently, massive personal flaws are irrelevant to the rich as long as that person can rubber stamp policies conducive to making the rich even richer.So, what policies might these be:Education - This should be stunningly obvious that by controlling the availability of education, the rich can limit who can become rich. If you can't learn how the world works, you can't compete with the rich. In an extreme form, that's how some societies have subjugated women, by prohibiting them from being educated. Here in the US, the rich, which has been running the Republican Party, has been working hard to defund public education at every step of the way. This limits access to education for the poor and for those willing, they are burdened with huge student debt for the perceived privilege of being educated.Our current student debt explosion is a direct result of these policies. So, even the most ambitious and successful graduates are hobbled financially for decades by the non-dischargeable student debt. This works great for the rich who can pay for easy access to the best schools for their children. So today, Department of Education Secretary Betsy DeVos is actively working to defund her department, defund public schools, close affordable vocational schools, and redirect money to private schools with vouchers, which enriches the rich who own the schools and lets the rich decide who gets educated.Taxes - This is the most direct and egregious form of subjugation of the poor. Once the rich gets to control government, the first order of business is to pass tax cuts for the rich and bleed support programs for the poor. After all, the rich already pay a lot of taxes, as they make all the money, so if they get to control how much taxes they pay, they'll want to reduce it. Since the rich make most of their money with passive investments and not through salary, then it makes a ton of sense to lower taxes for capital investments and raise taxes on earned income.For the rich, they can enjoy 15% capital gains tax rates on carried interest and long-term investments while the poor pays up to 39.6% in federal income taxes. Warren Buffett is a huge beneficiary and critic of this system as he pays a far lower, even negligible, tax rate as compared to his secretary. Even semi-rich businessmen get a tax break as they get to write off their expenses before taxation while their workers are taxed first before expenses. While I'm a beneficiary of both forms of tax breaks, I'm still very concerned about the long-term damage done to our society.Meanwhile, the narcissistic Trump administration and his cabal of GOP minions (led by Mitch McConnell) are proposing even more egregious wealth transfers. Ostensibly sold as a repeal of the Affordable Care Act or Obamacare, the proposed Trumpcare or American Health Care Act (notice it says nothing about making health care actually affordable) is a giant transfer of wealth from the poor to the rich. By cutting Medicaid, which covers our veterans and tens of millions of Americans, and other funding for programs like Planned Parenthood, the proposed law would transfer between $800 billion to $1 trillion in tax cuts from the poor, sick, elderly, and veterans to the rich, mostly white people in power.As before, I would be benefitting from this new tax cut as well, which mostly targets the areas of the country foolish enough to vote for Trump in the first place. While there's a bit of schadenfreude, I would vigorously fight such a mean-spirited new law. This secretive new law (drafted behind closed doors) is so ridiculously filled with largess for the rich that even Trump is a shade embarrassed by it. Consider that for a moment. We’re talking about a half-man who has no qualms about cheating hard working contractors, defrauding suppliers, and cheating on his wives actually feeling bad about how mean the AHCA is. That's mind blowing.And, as long as Trump’s supporters keep standing behind him blindly (about 36% of the country still does, inexplicably), we will have even wider gaps between the rich and poor.What will I do about it? Do I think all my vigorous protests against what my Republican Party is doing to my fellow Americans on Quora and other social media does anything? Probably not, but I still hope. Rather, I think I can do more good by helping fellow Americans when this law passes (as the rich will have their way) and maybe by bringing another perspective when I'm in the company of those who are only too pleased with the current state of affairs.

Yes, as an active duty military member during the period of this answer, I was covered by single-payer healthcare almost identical to the UK’s NHS system. The only real differences are that in the UK everyone is enrolled, but can opt out by paying private doctors, while in the active duty military system, only the active duty, retirees, and military dependents are enrolled. Also, active duty can't opt out: we're prohibited from procuring outside care due to military readiness concerns.In 2013, I had a tumor in my foot removed. When the fat pad didn’t grow back, I requested a fat graft to replace it, which is something done very frequently in plastic surgery centers (but usually so rich women can wear high heels more easily). Tricare denied me, so I appealed. The appeal took 1.5 years to maneuver the bureaucracy before I transferred across the country with it unapproved.Once I arrived on the other side of the country, I had to start all over. It took me 2 months to get an appointment at Langley with a podiatrist; he concurred with the request for a fat graft. The military medical system recaptured the request and made me see another podiatrist in Portsmouth, which took another month to get an appointment. He didn’t understand why I was sent there because Portsmouth isn’t experienced with fat grafts, and concurs that fat graft is the most conservative option. He requests a fat graft out in town, but Portsmouth Naval Hospital exercises their right of first refusal and makes me schedule an appointment with their Plastic Surgery clinic, which takes another month to get an appointment.When I see Portsmouth Naval Hospital Plastic Plastic Surgery, he also can't understand why I was sent there because Portsmouth Naval Hospital has zero experience with weight bearing fat grafts, but concurs that fat grafting is the most conservative option. He puts in a referral for a specific doctor who is experienced in weight bearing fat grafts. Tricare tries to refer me to Portsmouth Naval Hospital Podiatry again, but I fight back for a month and was able to make an evaluation appointment with the doctor (ironically, his only availability was on Veteran's Day, which is two months away from this time frame).Two months later I see the surgeon, who declares I’m a prime candidate for fat grafting, although the 2 years I’ve now had to wait has increased the risk of failure significantly.1 month later, Tricare marks the surgery request as received. Tricare refers me to Portsmouth Naval Hospital Podiatry for the surgery, and even to the specific doctor who told me he can’t do the surgery. Three days later, the surgery is denied as “not a covered procedure.”An O-5 in Portsmouth Plastic Surgery states via email that she "was told to instruct [me] to contact [my] congressman to help get this resolved. Please let us know if there is anything else you might need assistance with. Have a Happy Holiday Season." I call the supervisor of Patient Advocacy; he tells me that Tricare only approves procedures that have a large number of finished studies for that specific procedure addressing my specific condition, and that the DoD has given HealthNet sole authority to determine what is and is not covered. He wouldn't address my questions regarding what responsibility (if any?) Tricare bears in getting me healthy. He told me that filing for the Defense Health Agency waiver referred to in the letter was "worthless," as "in three years of being here, I've only seen it succeed once, and it was almost too late for the person who needed the lifesaving cancer treatment." He also told me that my only real recourse was to call my Congressional Representative(s).2 weeks later I’m able to get my PCM to write a referral to Walter Reed. Referral sits in limbo for 2 weeks. I also officially request a waiver for the fat graft procedure.At this point, it’s probably easier just to copy my journal notes into the answer so you can see what life is like for a someone in the military medical system:25Jan13 - Removed neuroma.22Mar13 - "mild erythema with continued fibrosis" - hydrocortisone injection.03May13 - "mild edema with acute tenderness to palpitation of the fibular sesamoid. We discussed possible capsulitis. Treatment today included a TPI with 5mg of Kenalog instilled into the symptomatic joint space." Dr. <redacted> discussed removal of the sesamoid bone; I requested a second opinion. Did not receive any response from Tricare on approving the request (even w/ significant followup from me) until 05Sep13.Sep13 - Went to see Dr. <redacted>, DPM, Oxnard, CA for second opinion. He recommended fat grafting into the area. I asked him to put in the referral request. Due to the poor communication skills of himself (limited English) and his staff (other reasons), I did not understand until 15Dec13 that he already knew that Tricare will not cover this treatment, and even if they did, there isn't a single plastic surgeon in Los Angeles or Ventura Counties that accepts Tricare.25Sep13 - MRI Right foot, Oxnard, CA: "ball of foot subcutaneous edema, consider changes related to altered weightbearing. A previously noted fluid signal structure about the first metatarsal is no longer evident."06Nov13 - I saw Mr. <redacted>, patient advocate at Port Hueneme Clinic. He was markedly unhelpful, essentially telling me to call Dr. <redacted> in Oxnard back.03Jan14 - Dr. <redacted>, PCM at Port Hueneme, CA specifically requests Tricare to "please authorize for surgical procedure to correct the loss of natural cushioning essential to prevent foot pain with walking or running."No action from Tricare, in spite of regular follow up, January through June of 2014.15Jun14 through 11Jul14 - Permanant Change of Station from California to VirginiaAug14 - I see Dr. <redacted> at in Hampton Roads who sends me to Langley Podiatry for consult.11Aug14 - I see Dr. <redacted> at Langley Podiatry. He takes an XRay and MRI. Xray information: Impression: 1. Bilateral pes planus. 2. Degenerative changes at the 1st metatarsophalangeal joint bilaterally. 3. Mild right hallux pelvis." MRI Information: "Findings: There is soft tissue distortion and blooming artifact at the base of the 1st MTP joint adjacent to the medial plantar sesamoid. This is most likely post surgical. The sesamoids themselves appear grossly unremarkable. Impressions: Postsurgical change at the plantar surface of the 1st MTP joint. Artifact is present here which limits visibility. No definite acute fracture or dislocation was seen. Edema in the 3rd interdigital space may be postsurgical. No soft tissue mass was identified." He tells me that there are two options - amputate sesamoid bone(s?) and hope for the best, or take the more conservative option and do a fat graft. He puts in a request for a fat graft out in town, but Portsmouth Naval Hospital exercises their right of first refusal and makes me schedule an appointment with their Podiatry clinic.03Sep14 - I see Portsmouth Naval Hospital Podiatry Dr. <redacted>, who can't understand why I was sent there at all, and concurs with Dr. <redacted from Langley> that fat graft is the most conservative option. He requests a fat graft out in town, but Portsmouth Naval Hospital exercises their right of first refusal and makes me schedule an appointment with their Plastic Surgery clinic. He does an Xray, which results in the following statements: "1. Mild hallux valgus deformity, 2. Small enthesophyte at the Achilles tendon insertion, 3. Flatfoot."25Sep14 - I see Portsmouth Naval Hospital Plastic Plastic Surgery Dr. <redacted>, who concurs with Dr. <redacted> and Dr. <redacted> from Langley and Portsmouth that a fat graft is the most conservative option, but can't understand why I was sent there at all since Portsmouth Naval Hospital has zero experience with weight bearing fat graft. He asks me what research I have done on my own. I tell him about Dr. <redacted> at the University of Pittsburgh Medical Center, who specializes in this treatment for foot injuries. He recognized the stature of both the Medical Center and Dr. <redacted> in this field once I mentioned the names and immediately requested a fat graft through UPMC. After fighting with Tricare over Portsmouth Naval Hospital exercising their right of first refusal again, I was able to make an appointment with Dr. <redacted> during his first available appointment - Veteran's Day 2014.11Nov14 - I fly to Pittsburgh and see Dr. <redacted> (a plastic surgeon) and his wife (a podiatrist). They tell me I am a perfect candidate for this procedure and put in a request for the fat grafting surgery.16Dec14 - After not hearing from Tricare I spend hours on the phone trying to get an update. They tell me they ignored the request (their words) because one number was missing in my identifier data from Pittsburgh. I provide the number and Tricare marks the surgery request as received. Portsmouth Naval Hospital exercises their right of first refusal again and an referral is automatically input for Portsmouth Podiatry. I call Tricare and after an hour on the phone got them to assess it internally.19Dec14 - Surgery denied by Tricare / Health Net. Reason given is "not a covered procedure." CDR <redacted> of Portsmouth Plastic Surgery stated that she "was told to instruct [me] to contact [my] congressman to help get this resolved. Please let us know if there is anything else you might need assistance with. Have a Happy Holiday Season." I call Mr. <redacted>, the supervisor of Patient Advocacy; he tells me that Tricare only approves procedures that have a large number of finished studies for that specific procedure addressing my specific condition, and that the DoD has given HealthNet sole authority to determine what is and is not covered. He wouldn't address my questions regarding what responsibility, if any, Tricare bears in getting me healthy. He was very forthcoming in advising me on filing for the Defense Health Agency waiver referred to in the letter: he said it was "worthless," since "in three years of being here, I've only seen it succeed once, and it was almost too late for the person who needed the lifesaving cancer treatment." Mr. <redacted>also told me that in his opinion, my only recourse is to call my Congressional Representative(s).22Dec14 - CDR <redacted>, Portsmouth Hospital Plastic Surgery: " I apologize for this inconvenience that you are going through. I called around and I was told that there should have been "appeal" instructions on the letter that you received. If not, I was told to instruct you to contact your congressman to help get this resolved. Please let us know if there is anything else you might need assistance with. Have a Happy Holiday Season."29Dec14 - My primary care manager, LT <redacted> writes referral to Walter Reed. Referral sits in limbo for 2 weeks. I also officially request a waiver through LT <redacted> for the fat graft procedure.15Jan15 - Portsmouth attempts to take the referral away from Walter Reed per right of first refusal. I spend an hour on the phone to get it reconsidered.22Jan15 - Podiatry clinic at Portsmouth approves transfer of referral to Walter Reed.26Jan15 - Walter Reed appointment line tells me that all National Capitol Region clinics are full until April and to call back on 30Jan15.30Jan15 - Walter Reed appointment offers appointment 37 days away . I ask about the 28 day Tricare standard of care for specialty appointments; the appointment desk tells me that if I want to inquire about the procedure for when the clinic cannot meet standards of care, I should leave a message with referral management and someone will call me back. I leave a message asking for a nurse to call me back so we can discuss a way forward to get my foot treated.04Feb15 - Nurse <redacted> at Walter Reed cancels my appointment without contacting me. The reason given in the notes was “Service member refuses available appointments.”06Feb15 - I call Walter Reed to check on the referral and am told the referral is canceled.09Feb15 - I speak to <redacted> in Patient Advocacy at Walter Reed who doesn't help until I tell her that I want to file an official complaint against Nurse <redacted>. She tells me that active duty never get appointments that meet the 28-day requirement and that I need to stop insisting on being seen within 28 days or I'll never be seen.11Feb15 - <redacted> calls me back and says my referral is reinstated, but I will have to wait until 13Feb15 to make an appointment.13Feb15 - First available appointment is 20Apr15. I make the appointment, and specifically ask whether they had the ability to perform fat grafts and/or Restylane injections, and the appointment line said someone would get back to me.02Mar15 - Mr. <redacted> at Portsmouth takes first official action on my waiver request of 29Dec14. He forwards it to the grievance coordinator, Ms. <redacted> and promises a phone call from her on 03Mar15.09Mar15 - No contact from Portsmouth. I call Mr. <redacted>, who promises Ms. <redacted> will call on 10Mar15.11Mar15 - Ms. <redacted> via email: "I wanted to follow-up with you regarding your request for the fat pad graft procedure and/or treatment. I have emailed both Dr <redacted> and Dr <redacted> requesting that they both chime in with my leadership so we can try and formulate a decision. I am waiting still and as soon as I have something to pass on, I will contact you."16Mar15 - Ms. <redacted> via email: "Your request is being discussed among leadership. Im waiting for confirmation on who will draft the request for waiver for DHA. As soon as I have a definitive decision to forward, rest assured I will."18Mar15 - Ms. <redacted> via email: "It is my understanding that the DHA waiver is being drafted by the Plastics clinic folks. Im standing by waiting further details."20Apr15 - Dr. <redacted> at Walter Reed walks in to my appointment and immediately states "I'm not sure why you're here. We don't do the kind of thing you're requesting here at Walter Reed." He couldn't answer me as to why Walter Reed accepted a referral for something they don't do and/or didn't call me to inform me that the appointment would be a waste of time. I mention to him that I requested information as to their ability to do the procedure and no one got back to me. He prescribed insole and recommended that I see a pain management specialist as well as a rheumatologist for my hip and knee pain <as of 2017 this still hasn’t been approved either>. I made an appointment with the PCM for Monday, 27Apr15 to get these referrals and discuss the way forward.I forwarded my concern to the Officer in Charge at <redacted> Clinic, LCDR <redacted>, about how I was referred to a clinic who can't do the procedure requested. His response was "My only suggestion is that you contact the Patient Relations Department for Walter Reed at (301) 295-0156 and voice your concerns."22Apr15 - Ms. <redacted> via email: "I am touching basis this morning with my Chain of Command as well as Health Benefits regarding the current referral concerns you are experiencing. Please allow me a little time this morning to reach out to a few of the folks here at Naval Medical Center Portsmouth regarding what is best needed at this juncture to better assist you."24Apr15 - Commanding Officer Portsmouth returns Waiver for more information. <redacted> at Patient Advocacy tells me he will keep me informed.29Apr15 - I discuss my situation with Maj. <redacted> at Walter Reed Podiatry, who states she will not authorize Walter Reed to assist me beyond providing orthotics.May15 - Dr. <redacted> at Walter Reed Podiatry convinces his chain of command to allow Ossatron and Stem Cell Therapy. I make the appointment for surgery.10Jun15 - Ossatron and Stem Cell Therapy surgery is conducted at Walter Reed. As of 15Jul16, this has not improved the situation.17Jul15 - I request an update on my Waiver Request from Mr. <redacted> at Portsmouth Patient Advocacy via email. No response. I request Physical Therapy through my doctor to address the continuing degeneration of my Hips and Knees due to the lack of treatment for my foot.31Jul15 - I request an update on my Waiver Request from Mr. <redacted> at Portsmouth Patient Advocacy via email. No response.17Jul15 - I request an update on my Waiver Request from Mr. <redacted> at Portsmouth Patient Advocacy via email. No response.03Aug15 - I request an update on my Waiver Request from Ms. <redacted> at Portsmouth Patient Advocacy via email. No response.17Aug15 - I request an update on my Waiver Request from Mr. <redacted> at Portsmouth Patient Advocacy via email. No response.19Aug15 - I request an update on my Waiver Request from Mr. <redacted> at Portsmouth Patient Advocacy via email. He emails me back and states, "this has gone up the chain to Navy Medicine East. Mr. <redacted> and Mrs. <redacted> are aware of you contacting me regarding this matter and Mr <redacted> is following up with NAVMEDEAST on the status. I will contact him again today and advise to contact you regarding this matter." No one contacts me.I never hear from Ms. <redacted> or Portsmouth Hospital Patient Advocacy again, even after repeated phone calls and leaving messages asking them to assist.25Aug15 - 14Sep15: Pool Physical Therapy at Fort Eustis. They have me "run" and jump in the water 2-3 times a week. It takes me up to 30 minutes to recover from the pain enough to drive after the therapy. I call it off after 6 weeks because I can't take the pain any more.11Sep15 - I request an update on my Waiver Request from Mr. <redacted> at Portsmouth Patient Advocacy via email. No response.24Sep15 - I call the Patient Advocacy desk and don't take "no" for an answer. I never am able to talk to anyone, but the front desk refers to CAPT <redacted> at Navy Medicine East. He tells me that the waiver has been sent back a few times for format errors and still has not left Portsmouth since I requested it in Dec14 and/or when it was drafted in Mar15.30Sep15 - I call Dr. <redacted> at Walter Reed and ask if there is anything to do since the stem cell treatment failed. He recommends another round of treatment.27Oct15 - CAPT <redacted> forwards waiver to BUMED. No response through the rest of 2015.15Jan16 - I contact Dr. <redacted> for another round of shockwave/stem cell therapy while I wait for fat grafting. He forwards the request to a Ms. <redacted> to set up the surgery.29Jan16 - No response from Ms. <redacted>. I call her and leave a message requesting for her to call me back to set up surgery.10Feb16 - I email CAPT <redacted> to request an update and find out he has retired. I spend most of the day trying to find out who has action. A LT <redacted> is able to find hard copy information and request an update the same day. No response.15Feb16 - No response from Ms. <redacted> on my stem cell surgery. I call her and leave another message requesting for her to call me back to set up surgery.15Mar16 - No response from Ms. <redacted> on my stem cell surgery. I call her and leave another message requesting for her to call me back to set up surgery.16Mar16 - Receive a response from BUMED contractor <redacted> who states that the waiver (initiated in 2014) was submitted to Defense Health in early March 2016. I inform her that I will be changing assignments in July and that I need surgery before then. I also identify a target date of the last week in June for surgery due to my PCS. She promised to update me by close of business on 17Mar16. The update never occurs.12Apr16 - I have not heard from <redacted> since 16Mar16. I request a response and update, and remind her of the target date of the last week in June for surgery due to my PCS. She says she is "still working on my case" and will update me on 15Apr16 by COB. The update never occurs.14Apr16 - LT <redacted> at Portsmouth transfers, turning over my case to LCDR <redacted>.13May16 - No updates from <redacted> or LCDR <redacted>. I email both. <redacted> leaves a message on my voicemail telling me she wants to talk to me, even though my voice message says I’m on leave.26May16 - I hear the email and respond to <redacted> via email asking if I can provide any information, and remind her of the target date of the last week in June for surgery due to my PCS. She says she doesn't need anything and is still working on my waiver, but provides no actual information.06Jun16 - I request an update from <redacted> via email, and remind her of the target date of the last week in June for surgery due to my PCS. No response.20Jun16 - I request an update from <redacted> via email, copying my boss, and remind her of the target date of the last week in June for surgery due to my PCS. Her response is "As discussed I have submitted all of your paperwork to the DHA for consideration of your waiver request. I will send you a status update this Friday (and every week on Friday as previously stated) via email."It is important to note that at this point, not only have I not received "every Friday" updates, but I have received no response at all to many emails, and no information beyond "still waiting" since March 2016.24Jun16 - At 4pm I ask <redacted> if I will get an update and ask when I should schedule travel and surgery. Her answer: "I inquired this week on the status of your case. As of today I have not received an approval/disapproval decision from the DHA. I have a meeting scheduled on Monday of next week to specifically discuss your waiver request. I hope to have an additional update for you on Monday following my meeting."Tuesday, 28Jun16 - <redacted> asks me for my Primary Care Manager's name with no explanation. I provide this information along with all of the Podiatrists and other doctors who have referred me for fat grafting. I also ask when I should schedule surgery, and remind her that I start MBA classes 08Jul16. I also tell her that due to the compressed MBA schedule, I have a single open week starting 08Aug16 that I'm available for surgery.****At this point I have now transferred again, away from a friendly unit who knows my community and my job and into a bureaucratic student unit****11Jul16 - No updates since June. Requested an update from <redacted> via email. No response.14Jul16 - Request update again from Ms. <redacted>.15Jul16 - Email from Ms. <redacted>: "Your PCM will need to request a referral for an evaluation and treatment (to Dr. <redacted> who does the surgery) and submit that to Health Net for approval/disapproval. Once we receive an approval/disapproval from Health Net we can move forward to:(1.) get the surgery scheduled and paid via Health Net or (2) resubmitting the SHCP waiver request to DHA (with the updated information from Health Net) to get the surgery scheduled and paid via the DHAAs discussed during our phone call, I will contact your PCM (Yorktown Clinic) and assist with the request for a referral. I will contact you on Monday if there are any additional updates. Please contact me if you have any questions."It is important to note that I received disapproval from Health Net on 19 December *2014*, and it is only due to the lack of action by Tricare that it has taken this long.18Jul16 - I go to Clinic <redacted> and can't find anyone who knows anything about my issue. They insist I make an appointment, which is backed up until early August. I ask Ms. <redacted> who she spoke to and she emails back that she can't remember but that she would get back to me by COB. LPN <redacted> at the clinic takes my information and promises to discuss with LCDR <redacted> (my PCM) and get back to me by COB. Neither update happens.19Jul16 - Ms. <redacted> emails that she remembers who she spoke to on 15Jul16: Ms. <redacted>, the health benefits coordinator, who evidently did not speak to my PCM team. Ms. <redacted> says that she will coordinate with my PCM team.20Jul16 - A different nurse from the PCM team at Yorktown calls and says that LCDR <redacted> is unwilling to put in the referral (see 15Jul16 above) without an appointment. She sets up an appointment for 22Jul16.22Jul16 - I arrive and LCDR <redacted> doesn't know very much about my case. I ask him what he needs to write a referral, and he tells me I will need to go to Portsmouth Podiatry for an assessment. I relay this information to Ms. <redacted>, who responds "Please allow me to do my job and work through the TRICARE Health Plan program requirements. I will follow up with you and provide you with an update by close of business today regarding referral."She later emails to me: "I spoke with Dr. <redacted> this morning after your visit and he is generating a referral for Dr. <redacted> for an evaluation and treatment. You cannot schedule an appointment until the referral has been approved and an authorization number has been issued. Once the referral authorization number has been issued the appointment with Dr. <redacted> can be scheduled. I will contact you today when I have a status update on the referral request. Please do not make any Podiatry appointments at this time."26Jul16 - I ask whether my unit will need to fund the travel and when I will know what my surgery date is, and Ms. <redacted> response is:"I did not state that any appointments or medical services would be funded due to the fact that an authorization had not been issued. I will be contacting Health Net Federal Services, TRICARE Regional Contractor for the North Region) to confirm if an authorization has been issued. If a referral authorization is issued then funding can be coordinated.**Once again please do not schedule any appointments or initiate any requests for funding at this time. I will provide you with an update no later than 1700 today."Ms. <redacted> then spends a lot of time trying to coordinate a phone conversation with her supervisor without responding to my requests for an actual date of surgery. At the end of the day, she tells me that she will try to coordinate a surgery consult in Pittsburgh for 06Aug16, and will be contacting me with an update by COB Wednesday, 27Jul16. No response until I email her on Friday.29Jul16 - I ask Ms. <redacted> what the status is since I didn't get an update on Wednesday as she had promised, and I need to know what's going on so that I can schedule travel. She emails me back the Tuesday email, implies that I'm being impatient, and says that she will update me by COB Monday, 01Aug16.—————————————————Cue 5 or more additional pages of similar non-effective medical treatment and you’ll understand why I cringe inside anytime I hear anyone say they want to “give the whole country access to the level of care the active duty have.”Edit in response to some questions:1) AHCA doesn’t apply to military Tricare, as it was not only exempted but Tricare is considered full coverage.2) One of the biggest misunderstandings about health insurance, not just in the US but worldwide, is that insurance = care. Charlie Gard’s parents are finding out that there isn’t an unlimited checkbook when it comes to medical care - even government care has limits.3) For military healthcare, only those treatments specifically listed in the care handbook are covered. These treatments have billing codes and rates assigned. Tricare isn’t really a medical treatment plan, it’s a reimbursement plan for those items in the book. If you have a problem that requires a treatment not in the book, there is no burden on Tricare to find a way to treat you, they simply shrug and say “it’s not in the book.” It’s on you to prove that the treatment you want has been studied and the studies must have been published in multiple medical journals. If that’s the case, and you can find them, you might be ok, but otherwise you’re SOL.4) Tricare only allows military doctors to address one problem at a time. Thus, when I go to the doctor to address my back, hips, and knees that have degenerated due to the way I walk after the foot tumor, they tell me I need to make separate appointments for each knee, each hip, and my back - there is no concept of holistic medicine in the military medical system, or at least not since I joined in the mid-90’s.5) I personally know at least 10 people who have been or are currently being medically discharged due to preventable permanent injuries sustained due to the many month wait times in the military. Many have ACL, MCL, Hip, Shoulder, and other injuries which could have been easily fixed but healed improperly while they waited. All of these people will be at least partially supported by the taxpayer for the rest of their life, but there is zero ability to hold anyone in the military accountable to improve the system.