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My husband has orders for Hawaii; as of right now, the kids and I have been denied because of a behavioral health counseling that my son gets. The social worker recommends he goes once a month, but my son has been going once every two months without any problems. Do we get a second opinion, and do we also let the EFMP facility in Hawaii know that our son is on a waiting list for counseling at a doctor's office off base? Also, why are we getting denied if we know that we can go off base for the services that are needed for our son?
Exceptional Family Member Program (EFMP)
PCS
Advice
Family
Rules
Posted >1 y ago
Responses: 6
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What do you mean an EFMP appeal?
So - when I was at the end of my compassionate reassignment in Offutt AFB, NE (luckily they had a slot so I got 3 years instead of just one), I was trying to get somewhere closer to home. (From Nebraska originally). I had tried to get Hood. First time, they denied her EFMP, I hadn't updated it after she got her transplant (I had gone to SLC 2 months after she got it). So I thought oh they just don't know she had it. I updated it - they denied it again. I even called the EFMP coordinator at Ft Hood and she told me "They said they can't provide the services she needs" at the hospital. I did bring up that there's a transplant clinic right outside base 20 min and she had gotten no MTF care at Offutt. The coordinator said, when I asked what they couldn't provide, "I can't tell you exactly what but they said they can't provide the care she needs." I ended up with orders to JBLM after that.
Ultimately, it's not just about what's off base - and it's up to the MTF there if they feel comfortable with it, if they have the capabilities, if they have the right healthcare professionals, etc. You'll never find out why though. When I was at Offutt, before I went from Riley to Offutt, the Air Force nurse case manager at the clinic there (the hospital on base closed and was just a clinic) said the pediatrician there could see her, but with her being so complex, felt more comfortable if she was seen by Children's Hospital PCM. I said as long as TRICARE covers it I'm good. So that worked out but that was a compassionate.
When I was trying to PCS closer to home this last time, Ft Riley denied her EFMP (I knew that - she was born early and they had no NICU and every children's hospital is 3 hours away). Ft Hood denied it again. I almost had San Antonio. But branch lost it. So I'm staying put at JBLM.
Even when talking to my branch manager he said EFMPs are really hard for them to do because not every base can accept some EFMPs. They do their best to get people their preference though. Sometimes - when EFMPs are involved there are just places that soldiers can't go with their EFMP dependents.
How did he get orders with that EFMP? Did you have your child enrolled in EFMP already before he got them or no? I'm a single parent so my daughter comes with me or I'm not going. So I make sure her EFMP is current and that won't hold up anything.
So - when I was at the end of my compassionate reassignment in Offutt AFB, NE (luckily they had a slot so I got 3 years instead of just one), I was trying to get somewhere closer to home. (From Nebraska originally). I had tried to get Hood. First time, they denied her EFMP, I hadn't updated it after she got her transplant (I had gone to SLC 2 months after she got it). So I thought oh they just don't know she had it. I updated it - they denied it again. I even called the EFMP coordinator at Ft Hood and she told me "They said they can't provide the services she needs" at the hospital. I did bring up that there's a transplant clinic right outside base 20 min and she had gotten no MTF care at Offutt. The coordinator said, when I asked what they couldn't provide, "I can't tell you exactly what but they said they can't provide the care she needs." I ended up with orders to JBLM after that.
Ultimately, it's not just about what's off base - and it's up to the MTF there if they feel comfortable with it, if they have the capabilities, if they have the right healthcare professionals, etc. You'll never find out why though. When I was at Offutt, before I went from Riley to Offutt, the Air Force nurse case manager at the clinic there (the hospital on base closed and was just a clinic) said the pediatrician there could see her, but with her being so complex, felt more comfortable if she was seen by Children's Hospital PCM. I said as long as TRICARE covers it I'm good. So that worked out but that was a compassionate.
When I was trying to PCS closer to home this last time, Ft Riley denied her EFMP (I knew that - she was born early and they had no NICU and every children's hospital is 3 hours away). Ft Hood denied it again. I almost had San Antonio. But branch lost it. So I'm staying put at JBLM.
Even when talking to my branch manager he said EFMPs are really hard for them to do because not every base can accept some EFMPs. They do their best to get people their preference though. Sometimes - when EFMPs are involved there are just places that soldiers can't go with their EFMP dependents.
How did he get orders with that EFMP? Did you have your child enrolled in EFMP already before he got them or no? I'm a single parent so my daughter comes with me or I'm not going. So I make sure her EFMP is current and that won't hold up anything.
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There is no appeal for EFMP. You can try again in six months. If your spouse is PCSing soon, he can contact his branch manager to change the orders, or if he reenlisted for them, he can renegotiate for a different assignment.
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You might be getting denied because the places off base may only have so many slots for Tricare patients, and they may be all filled. So, its not a matter of whether they do or do not have services, its whether they have the space/time to service you.
(2)
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