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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,
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