Tricare... who is in control?

Christa - posted on 02/05/2009 ( 8 moms have responded )

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I am a military wife and we have been transfer from Hawaii to New York on an emergency transfer to help me through a medical problem. I had a double Mastectomy with a tramflap while station in Hawaii and had Major complications. I am having to have reconstruction now in another state but now Tricare is saying I dont fit medical standards ... After the surgery was already approved ... I had the surgery ...then they resended the approval. Where do I go. And who do I contact because I have hit a brick wall. The Bills are mounting but the surgery was not elective it was necessary. Any wonderful Ideas?

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Christa - posted on 02/10/2009

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To give an update I contacted the Insurance Commission of NY and the Superintendant of Insurance in NY both said Tricare was " Bigger " than them.  The Attorney General office is Appealing for me.  My Congressmen's office called and decided to work on my behave. We shall see what happens.  Thank you so much for your ideas.  I am still in a letter writing campain with my family and friends. Keep your fingers crossed for me.  I will let you know the results.

Christa - posted on 02/09/2009

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Quoting Angee:

When I had trouble with Tricare, my in-laws in different states, both contacted their congress & senators with the issue and I had a formal apology from them and all the help I needed with-in a month. It's really sad that that is what it takes, but it is. Please don't just give up, make them pay!



Wow I think that is a great idea.  I have a great big family and if they get on board  that just might help. I will try that.  Thank you

Angee - posted on 02/09/2009

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When I had trouble with Tricare, my in-laws in different states, both contacted their congress & senators with the issue and I had a formal apology from them and all the help I needed with-in a month. It's really sad that that is what it takes, but it is. Please don't just give up, make them pay!

Leigh - posted on 02/06/2009

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WOW,,that's horrible! I've had tricare prime for 14 yrs through my hubby who's in the navy and I've had at least 8 surgeries,,None like yours (different states etc..) , I dont know what to suggest but want to extend my deepest sympathy and hope you recover and stay strong ! It will work out!!  IF you have a PCP(primary care provider) even if it is from hawaii, I'd call that doc (not any nurse), but speak to the doctor, he/she might know who to contact,or maybe be able to contact or write a letter on your behalf?? I actually had Gastric bypass and a tummy tuck, both of which tricare prime covered 100%, and I know my surgeon played a huge roll with the billing and payment of those 2 surgeries! Good Luck

Karen - posted on 02/06/2009

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Some friends of mine had their daughter on December 23, and had to have surgery on Jan 20th. Tricare wasn't going to cover the surgery. My advice to them and to you (From my mother, who works on the Tricare contract with DHHS) is to go and file an appeal. 90-95% of the time, when an appeal is filed, it will be approved. Thats your best bet. If that doesn't work, go higher up. Commanding officers, Congressmen, Senators. Do what you have to do to get Tricare to approve it. Take it public if you have to.



I wish you the best of luck. Keep us updated!

Meghan - posted on 02/06/2009

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What I can tell you from personal experience is TriWest is awful. When your husbands PDS is in a different region then where you are located things get complicated. I was pregnant with our son and living in Washington and hubbys PDS was Lejeune. Needless to say I had to go through a lot just to get the proper insurance. Call Tricare and talk to one of their case specialists and let them know your specific situation. Hopefully they will let you know  what you need to do specifically. It will work out Im sure especially if its been approved already.

Christa - posted on 02/06/2009

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Quoting Kat:



My husband just shouted when i read this out to him, Congressman, thats gonna be a good shot. If the base is not helping with this issue, and my heart goes out to you hun, then contact your local congressman. They will have the legal side down and should be willing to fight your corner. 






Hey im really concerned, would you let me know what comes? 






Kate xox A concerned Airforce wife about to pcs stateside from England.x






I appreciate your concern and I am going to take your husbands Advice.   I am not on a base now because we have been transferred closer to family. I think that is the problem.  We are on tricare Prime Remote because there isnt a base within a hour distance.  I contacted the Insurance commision in New York but they said that Tricare was "bigger than them" They said it was the difference between state and federal and I was caught in the middle.

[deleted account]

My husband just shouted when i read this out to him, Congressman, thats gonna be a good shot. If the base is not helping with this issue, and my heart goes out to you hun, then contact your local congressman. They will have the legal side down and should be willing to fight your corner. 



Hey im really concerned, would you let me know what comes? 



Kate xox A concerned Airforce wife about to pcs stateside from England.x

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