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[IP] Tricare Military Denied

I just found out Friday that Tricare denied authorization for me to get the 
pump (From the Patient Representative at Ft. Campbell). She told me from the 
research she could gather that the reason they denied my request was because 
they didn't have enough information. (So why didn't they request more???!!) 
She told me that I should be getting a letter from Tricare explaining why. 
Well, I did get a letter Friday, the nice "generic" form letter type.
Quote: "Your request for the Insulin pump cannot be authorized. A review was 
conducted using approved DoD criteria and all available supporting 
information. Anthem Alliance (Heartland Region 5) has determined that your 
request is not a covered benefit. . .  If dissatisfied with this decision you 
may request and appeal . . . All appeal requests must be received within 90 
days of the date of this notice. I tried calling them and went through the 
phone menu's, by the time I TALKED to someone she didn't have a clue as to 
who I could talk to as to what I should include in my appeal. I asked her if 
she could PLEASE connect me to someone in Dayton, OH (Region Hqtrs) and the 
menu asked me to enter my provider #. Well, obviously I got disconnected 
because I don't have one!!
The thing that I don't get is if they aren't going to listen to my doctor are 
they really going to listen to me?? The only thing that I can think of to 
include in this appeal is desperately pleading, and flood them with all of my 
previous lab work. Apparently my military doctor didn't look at my civilian 
records, and just included the lab work that HE had done. (I've only been 
here since July.) We had been stationed in New Orleans and because it is a 
small military installation I had to see a civilian doc. Civilian records are 
kept at the back of your records folder and I guess my military doc didn't 
know this. (There are 3 different sections.) The things I am learning!! He is 
a Captain (Army)  and should know this even though he's only been in a few 
years. I am sorry . . . I am rambling. I'm just so upset. Do I have to be on 
dialysis or blind before they consider me??
Question for fellow Tricare members: Did anyone have similar problems getting 
on the pump, and/or what measures did you have to take to get approved? 
The MM rep had called me a few days earlier to see if I had received the 
literature/tape that they had sent. She asked me for some info and told me I 
would be an EXCELLENT candidate for the IP.
Thanks for any suggestions,
Sally =o(
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