Insurance contractor change

[Guest guest]

Hi all, I have been reading this site ever since I found out I would

need lower advancement surgery ( over 3 years ago). It has answered

all of my questions about braces and surgery until this week. I have

been in braces for 16 months and I have my surgery date set for this

Friday. I am a military spouse and my insurance is Tricare ( Champus

standard). My surgery and braces were approved about 18 months ago,

after review by two seperate panels, (one for the braces and one for

the sugery). This authorization process led to years of delay in my

treatment starting. My care started at a military treatment facility,

but, when we moved base 6 months ago, Tricare looked at my case again,

and authorized my treatment to continue with a civilian orthodontist

and surgeon. My closest military hospital is a 3 hour drive from my

home and I don't think they are accepting new patient, so doubt if I

could obtain treatment there.

My problem is that, on July 1st, Tricare West changed contractors. The

old contractor had authorized my surgery for July 9th ( a date after

the contractor changeover ) and now, the new contractor isn't

authorizing the surgery.

I have surgical hooks on and have done all my pre-op physical/ blood

tests etc. I have 2 small children and have made plans to have them

cared for while I am recuperating. I am all set to have the surgery,

and want to get it over with so desperately.

Has anyone on this board had similar issues? I am contemplating having

the surgery anyway, assuming the financial responsibility and just

hoping that the new contractor will cover it. Is this too risky an

approach to take? Can a new contrator not cover surgery already

approved by the previous contractor?

Thanks,

Clare

[Guest guest]

I don't know the answers, but to me this is just one more example of

how insurance companies can be bureaucratic, insensitive and almost

harassing to the people who buy their services.

I hate it! For you -- my own experience was most excellent. But how

anybody supposedly in the business of understanding (and passing

judgment on paying for) these procedures could yank you around like

this is beyond my comprehension.

Sorry I'm not an insurance pro. And I hope there's someone here who

is and can help.

Best thing I can offer is: Call your surgeon and ask what he/she

thinks you should do.

Cammie

> Hi all, I have been reading this site ever since I found out I would

> need lower advancement surgery ( over 3 years ago). It has answered

> all of my questions about braces and surgery until this week. I have

> been in braces for 16 months and I have my surgery date set for this

> Friday. I am a military spouse and my insurance is Tricare ( Champus

> standard). My surgery and braces were approved about 18 months ago,

> after review by two seperate panels, (one for the braces and one for

> the sugery). This authorization process led to years of delay in my

> treatment starting. My care started at a military treatment

facility,

> but, when we moved base 6 months ago, Tricare looked at my case

again,

> and authorized my treatment to continue with a civilian orthodontist

> and surgeon. My closest military hospital is a 3 hour drive from my

> home and I don't think they are accepting new patient, so doubt if

I

> could obtain treatment there.

>

> My problem is that, on July 1st, Tricare West changed contractors.

The

> old contractor had authorized my surgery for July 9th ( a date after

> the contractor changeover ) and now, the new contractor isn't

> authorizing the surgery.

>

> I have surgical hooks on and have done all my pre-op physical/ blood

> tests etc. I have 2 small children and have made plans to have them

> cared for while I am recuperating. I am all set to have the surgery,

> and want to get it over with so desperately.

>

> Has anyone on this board had similar issues? I am contemplating

having

> the surgery anyway, assuming the financial responsibility and just

> hoping that the new contractor will cover it. Is this too risky an

> approach to take? Can a new contrator not cover surgery already

> approved by the previous contractor?

>

> Thanks,

>

>

> Clare