Tricare Appeal

[Guest guest]

Hi,

I am wondering if anyone is/or has had any success with receiving

reimbursement from Tricare for the cost of the helmet/band.

Thanks for your help,

Stacey San , TX

[Guest guest]

we just had one of those!!!!!!!

[Guest guest]

Hi Stacey,

If you can look back through the posts for this week you will see one called

Tricare Pays. This is the first person with Tricare who we have seen get

their claim paid. She has offered her help to others so you might try

emailing her directly. Let me know if you need help finding her email address

or the post I am referring to!

Welcome to the group and I'm sorry to hear of your insurance problems!

Marci (Mom to )

Oklahoma

[Guest guest]

HI Stacey:

Yes, Christi, Mya's mom JUST rec'd Tricare approval of her daughter's

DOCband I think this week or maybe last week. She's the only person

I can remember to get Tricare to cover a helmet or a band. I'm sure

she'll reply to you with help. Good luck!=

Debbie Abby's mom DOCGrad

MI

> Hi,

> I am wondering if anyone is/or has had any success with receiving

> reimbursement from Tricare for the cost of the helmet/band.

>

> Thanks for your help,

> Stacey San , TX

[Guest guest]

Hi Joanne,

I see you have already received some good information from other members. For

the first 1 year that I was a member of this group no one EVER got covered by

Tricare. There seems to be a trend in the other direction now. Hopefully

knowing that others have recently received coverage will aid you in your

insurance appeal.

Check out our files section for some good appeals info.

Marci (Mom to )

Oklahoma

[Guest guest]

Hi Joanne,

I searched the archives and this is what I found, I'll copy/paste it

below:

Hi stacey

I am sorry to hear you are fighting Tricare. What state do you live

in? Different parts of the country have different contractors for

Tricare. FOr example the contractor for Tricare for NC is Humana.

Different contractors have different policys. ANyway does your son

have exactly Positional Plagio? If not you may be able to win it

easily. My daughter Mya has Congenital Plagio because it happened

inutero. THe policy for Tricare states the DOC band is an exclusion

to the policy for treatment of Non synsototic (not sure how to spell

that)positional plagiocephaly. But since Mya didnt have exactly

positional plagio then they had to approve it. It took a while. Weve

been fighting since feb. Mya was casted on feb 19 and we made our

first 600 payment to cranial tech after first recieving denial from

tricare. SHe was then banded on March 6. and we have made 600

payments every month. Tricare had payed 1050 of the money at one

point. Saying they would only pay that amount since we went ahead

with treatment without authorization.So we fought some more saying

how do we get auth. when we were denied. So after lots of fighting

and we never wrote a formal appeals letter. WE went to Generals and

wrote to many many congressmen on this issue who then called Tricare

and we also had the Inspector General of Womack and also the Chief of

Pediatrics of WOmack and the COmmander of WOmack all calling Tricare

and trying to help us out. My husband went up through his chain of

command and no one could help and thats how we ended up talking to

Generals. Anyway Tricare eventually approved it and payed Cranial

Tech the rest of the money which after they had paid 1050 then they

only owed 1950 of the 3000. SO then Cranial Tech sent us a refund

check for the amount of money we had paid out of pocket which was

1800. I hope this helps some. If you have any questions or if I can

help in any way please email me at christiz75@a...

Good luck!! and keep me posted

christi mom to mya DOC band (3/6/02)

AND

If anyone in the TRICARE system runs into any problems what-so-ever

please feel free to drop me a line a thogan@c... I'll be

glad to discuss TRICARE and be a reference for TRICARE battles.

Take care and stay safe!

Tom

It looks like in 2000, Tricare wouldn't pay for a band at all. I

think they may be coming around now.

I emailed Christi, (she posted the first post, I pasted for you)she

too has Tricare, she was able to get them to pay. She's really busy

home schooling her children, so I sent her an email, telling her you

need some help. I'm sure she'll reply as soon as she can!

Welcome to the group!!!!

> Hello All,

>

> My Daughter Cameron has had her DOC Band for almost a month now,

and

> we just recieved the claim denial from Tricare, I have heard that

> several people have got Tricare to pay for the Band, but I have no

> clue what I am doing when it comes to Insurance as I am from the UK

> where Health Care is Government paid for. If anyone can help with

> what I need to put into an appeal I would be so grateful.

>

> Thanks Joanne.

[Guest guest]

Hi Joanne & welcome to our group!

I am happy to see was quick to reply with some very helpful

Tricare information. I suggest emailing both the people who beat

Tricare to get their help. I'm sure they'll be more than happy to

help you.

What was Tricare's reason for denial?

How is Cameron doing in her DOCband? Have you seen good

improvement? How old is she?

Welcome again - we hope you beat Tricare! Please keep us posted.

Good luck.

Debbie Abby's mom DOCGrad

MI

>

> > Hello All,

> >

> > My Daughter Cameron has had her DOC Band for almost a month now,

> and

> > we just recieved the claim denial from Tricare, I have heard that

> > several people have got Tricare to pay for the Band, but I have

no

> > clue what I am doing when it comes to Insurance as I am from the

UK

> > where Health Care is Government paid for. If anyone can help with

> > what I need to put into an appeal I would be so grateful.

> >

> > Thanks Joanne.