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ANSBACH, Germany (March 7, 2013) -- Some degree of confusion is nearly unavoidable during an overseas permanent change of station, a reality that applies just as well to Department of Defense civilians and their family members.

This confusion can and does extend to medical care, especially in a different county with a different language and culture, as well as a number of different medical procedures and standards.

It's often too late -- once an employee or family member suffers a fracture, infection or an unexplained muscle pain, for example -- when the question of "Where do I go for treatment?" comes up.

Fortunately for DOD civilians and their families, two main options exist: seeking off-post medical attention from a German health care specialist or scheduling an appointment with an on-post health clinic.

The caveat with the second option, however, is that on-post health care for DOD civilians and their families is designated as space-available. What does this mean for them?

According to Barry Donalson, group practice manager and health systems specialist supervisor at U.S. Army Health Clinic Katterbach, there is no simple, straightforward way to answer that question and a host of variables affects whether a DOD civilian can secure an on-post appointment.

Handling this juggling act of scheduling is a major part of what Donalson does at USAHC-Katterbach. Furthermore, Donalson said the process USAHC-Katterbach uses to decide whether a civilian may be seen on post differs across military communities.

Common to overseas U.S. Army garrisons, however, is the priority for service members and their families. As stated in the Army's Civilian Human Resources Agency (Europe Region) employee handbook, "What treatment is available will depend on where one is assigned, but the priority for care is always the same -- after active-duty military members and their families."

"Don't make the [on-post] clinic your primary source of health care," Donalson regularly tells DOD civilians. There might be days you show up here and you might want to get something done, and they're at capacity -- we may have one or two doctors out."

Donalson said the amount of space available can change quickly, such as this month with returning Soldiers undergoing redeployment processing. Plus, as more Soldiers continue to return here from Afghanistan, less on-post space will be available as a result of higher numbers of Soldiers seeking routine care. This all means civilians need to become comfortable with seeking care off post.

Donalson recommends that newcomers look to their assigned sponsors or other fellow employees who have enough experience with off-post care to help them make a decision. Important to that decision is ensuring the off-post health care provider accepts the right insurance. If not, the employee may have to pay medical costs out of pocket once the bill arrives.

"If stationed in Germany, most doctors and dentists don't require payment before leaving their office, but the bad news is most won't file a claim with the health insurance carrier either," the CHRA handbook states. "Once employees have paid the local health care provider, they will need to submit a claim to their health insurer for reimbursement of the covered portion of their treatment."

John O'Brien, USAG Ansbach special projects officer, is a Department of the Army civilian who has years of experience with off-post health care for him and his family. Although he said his experience is slightly different than most civilian employees in navigating off-post clinics and pharmacies because his wife is a local, he said there is no shortage of people in the Franconia Military Community willing to help and advise -- including sponsors and local national employees who work shoulder to shoulder with their American counterparts here in USAG Ansbach.

"I think the best thing to do is associate yourself with people that you know that are connected in the community," O'Brien said, "and just be willing to ask questions and listen to their recommendations as to where you should go."

O'Brien said, based on his experience, quality of care in Germany is no different from in the states, but he has noticed certain differences in procedure and a difference in cost -- generally lower from his point of view.

"They're extremely thorough," he added, "and, at least the people I've worked with, are very open to working with Americans in their treatment. They speak English well too. ... You'd definitely want to look for an office that's English-friendly if you don't have a connection to somebody who can go with you and translate for you."

For those adamant about trying to get on-post care, Donalson said, even for acute care availability on post can be "hit or miss when you come here based on what's going on," he said. "If it's a normal day? Yes. You might wait an hour or so; some days you might just come right in -- if you hit that appointment just right."

For routine care, he said, staff will still try to fit a civilian into the schedule, and the term "case by case basis" applies absolutely to on-post scheduling. A patient with a cut on his finger, for example, may unexpectedly need quick treatment if there is a reason to believe it is infected. Furthermore, a doctor might not be available for that patient, but a nurse might be.

On the flip side, Donalson said even a civilian with an appointment with the on-post clinic could be turned away when a Soldier or his or her family member needs care. Since that Soldier or family member has priority, Donalson recommends civilians recognize that such a circumstance is a real possibility. When trying to explain the process to potential patients, Donalson compares such a situation with space-available military flights, where a military retiree already on the plane with ticket and bag in hand can get "bumped" off the flight by a family member of an active-duty service member who has priority.

"Well, right after that," Donalson said, continuing the example, "an active-duty service member can tap that spouse on the shoulder and say, 'Hey, I need this seat,' and bump you. I've told them it works almost the same way in the clinic."

So if you are a civilian, how can you lock in a spot at the on-post clinic? The bottom line is you simply can't, Donalson said, but there are plenty of quality options in the area.

For more information, including locations, departments and contact information for host nation facilities, visit For information on medical care for civilian employees, the Army's Civilian Human Resources Agency (Europe Region) employee handbook is accessible through