Re: Christi-Mya's mother re: Tricare appeal

[Guest guest]

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@...

Good luck!! and keep me posted

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

> Hi Christi,

> I read your post regarding success with Tricare reimbursement-

> Congratulations! I am currently fighting the same battle and am

> wondering if you happen to have any advice. Did you pay for the

band

> upfront and then later receive reimbursement from Tricare or did

they

> initially pay for the band? Any suggestions would be greatly

> appreciated.

>

> Thanks so much for your help,

> Stacey-ph's mother

[Guest guest]

Christi,

Thanks so much for your message-I really appreciate hearing the whole

story and all your help.

Stacey

> > Hi Christi,

> > I read your post regarding success with Tricare reimbursement-

> > Congratulations! I am currently fighting the same battle and am

> > wondering if you happen to have any advice. Did you pay for the

> band

> > upfront and then later receive reimbursement from Tricare or did

> they

> > initially pay for the band? Any suggestions would be greatly

> > appreciated.

> >

> > Thanks so much for your help,

> > Stacey-ph's mother