Friday, Aug. 31, 2007 | 8:07 a.m.
Combat photographer Sgt. Nicholas Raven was deployed for 10 months in Operation Enduring Freedom. But his scars, he says, come from battling bureaucracy - the military's health insurance system.
Raven spent 10 months in North Africa documenting skirmishes with tribal warlords, a deadly helicopter crash and corpses in morgues.
During his tour, Raven suffered a torn biceps tendon while lugging gear and a hernia and broken teeth in a fall. He and his wife, Paulette, say it was difficult to get medical treatment because the insurance company contracted by the military made it impossible to enroll and denied benefits that he should have received.
As a result, the couple had to pay about $5,500 in out-of-pocket expenses and were targeted by collection agencies for unpaid bills.
The insurance company, TriWest Healthcare Alliance, sub contracts with Tricare, the health coverage provided by the Defense Department, to care for 2.9 million troops in 21 states.
The shoddy assistance provided by the private company for U.S. military personnel wouldn't pass muster in the private sector, the couple said.
"If he was my employee and I treated him this way for a work-related injury, then I would no longer have a company," Paulette Raven said. "So why is the federal government above the standards that other companies are held to?"
Raven, an Air Force reservist, was relatively unhurt after military deployments in conflict zones such as Haiti, Honduras and the Philippines.
But after his most recent deployments, he has cursed at strangers, fought with his wife, screamed and wept. He blames the rage and frustrations on TriWest, which he says has blocked his recovery.
TriWest officials are familiar with Raven's case and acknowledged that unacceptable mistakes were made.
"These things need to be handled smoothly and invisibly from the perspective of the person seeking care," said Scott Celley, TriWest's vice president of external affairs.
The problems in the military health care system are widespread and were the subject of a July report by President Bush's Commission on Care for America's Returning Wounded Warriors.
The report recommended urgent and fundamental changes that included simplifying the complex systems and focusing on patients.
Officials from TriWest, which is based in Phoenix, said some of the confusion in the system stems from extending coverage to Reserve and National Guard units when they're deployed to fight global terrorism or the war in Iraq. Benefits were extended incrementally and in different ways depending on the length of a person's deployment, TriWest officials said, and rules changed every year.
The Ravens did not get off to a good start with TriWest. In December 2005, days before Nicholas was to leave for North Africa, they applied for Paulette Raven to be covered by the insurance policy . That should have been her right, TriWest later told the Sun . The couple filed the application with an insurance clerk at March Air Reserve Base in Riverside, Calif., where Raven's unit is based. The clerk said there was no point submitting it because Paulette Raven did not qualify for benefits, and she proceeded to shred the application for privacy reasons.
Yet, three months later, Paulette Raven received a government letter explaining her benefits under the very insurance she had been denied.
The real problems started when Raven returned from North Africa in September. He needed abdominal surgery to fix a hernia, repairs to five broken teeth and follow-up visits to an orthopedist and neurologist for a biceps tendon tear that had been operated on in the field. The couple were dismayed to discover the military miscategorized him in the database that TriWest consults to determine who's eligible for coverage.
To fix the problem, Raven went to Nellis Air Force Base to correct the database entry and to visit a different TriWest office, hoping he could have his medical needs addressed immediately.
Four days later Raven was told his TriWest insurance was the wrong designation for treatment at Nellis, so he was sent back to the insurance company's offices in Reno. There he was told to go to a facility in Los Angeles for care or a referral. But when Raven called the facility in Los Angeles, he learned it was a clinic, not a hospital , and that it wouldn't see him anyway because, again, he had the wrong designation of TriWest insurance.
It took the intervention of a U.S. senator - John Ensign, R-Nev. - to get Raven enrolled in the appropriate insurance plan. The couple said no one from TriWest ever apologized for the confusion.
In the ensuing months Raven's medical and dental procedures were completed - and the insurance company started denying claims. By now Raven had other health insurance, and because his injuries were mistakenly not designated as in the line of duty, TriWest said the other insurance company should foot the bill.
TriWest officials said some of the claims were denied because providers did not give the insurer enough information. But meanwhile, the Ravens' account was sent to collections for payment.
Paulette Raven said in 15 years with her husband she's never seen him so despondent. One time, after arguing with TriWest, she feared he was having a mental breakdown.
"He got off the phone, he slid down the wall and he sat on the floor and cried," Paulette Raven said. "And I have never seen him do that."
Raven said he has many Air Force Reserve colleagues with similar problems with TriWest, but it's considered taboo to publicize it. He said he's talking about it because he wants to be the last person to have such problems. People are not getting treatment because of the problems, he said.
"This is our government-given right," he said. "It's a benefit given to us by the United States government that we have earned. It is not a bonus. It is not something you get because they feel like it. "
On Tuesday Raven was deployed for a third time to North Africa. He said he knows how to fight the system , so he does not expect a repeat of the problems.
On Thursday TriWest said it had processed and paid all of Raven's claims.
Raven will believe it when he sees it.
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