Guest guest Posted March 20, 2009 Report Share Posted March 20, 2009 You absolutely can and should appeal. We are in the appeal process with TRICARE right now. Mom to Liam, 8 monthsSTARBand since 2/25/09Sent from my Verizon Wireless BlackBerryFrom: "ambloved" Date: Fri, 20 Mar 2009 05:37:09 -0000<Plagiocephaly >Subject: Tricare help, PLEASE! Anyone know how Tircare paid for the helmet when it is on the " government no pay " list? I was told that I CAN'T even appeal. Help! Annie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2009 Report Share Posted March 20, 2009 Is there a formal process or do I write an " you should reevaluate your decision " type letter? By the way Medicaid in several states pays for helmets, so I really don't understand this " government no pay list. " Annie > > You absolutely can and should appeal. We are in the appeal process with TRICARE right now. > > > Mom to Liam, 8 months > STARBand since 2/25/09 > Sent from my Verizon Wireless BlackBerry > > Tricare help, PLEASE! > > > Anyone know how Tircare paid for the helmet when it is on the " government no pay " list? I was told that I CAN'T even appeal. > Help! > Annie > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2009 Report Share Posted March 21, 2009 When you receive your denial letter from TRICARE detailing the reasons for the denial, it will give instructions on appeal protocol. Ours said that it was not covered because it was for non-synostotic plagiocephaly. So basically, TRICARE has no issue with the orthotic device IF you let the neurosurgeons do surgery first. No logic at all. Anyway, once you get your letter, you have 30 days to file the appeal. You can mail or fax it in. I suggest letters from the specialists your little one sees. We got letters from the craniofacial board, neurosurgeon, plastic surgeons and the orthotist we use for the STARband saying that it was not for cosmetic purposes, but to avoid developmental issues and potential surgery. We had input from the Naval hospital as well as civilian providers. We also included the AMA documentation about orthotic devices not being cosmetic. Good Luck!Mom to Liam, 9 monthsSTARband since 2/25/09Sent from my Verizon Wireless BlackBerryFrom: "ambloved" Date: Sat, 21 Mar 2009 05:16:32 -0000<Plagiocephaly >Subject: Re: Tricare help, PLEASE! Is there a formal process or do I write an " you should reevaluate your decision " type letter? By the way Medicaid in several states pays for helmets, so I really don't understand this " government no pay list. " Annie > > You absolutely can and should appeal. We are in the appeal process with TRICARE right now. > > > Mom to Liam, 8 months > STARBand since 2/25/09 > Sent from my Verizon Wireless BlackBerry > > Tricare help, PLEASE! > > > Anyone know how Tircare paid for the helmet when it is on the " government no pay " list? I was told that I CAN'T even appeal. > Help! > Annie > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2009 Report Share Posted March 22, 2009 May I ask...are you Tricare Prime or Standard? My son Aidan wore the Hanger cranial helmet from Oct.-Dec 08. We are TriCare Standard and had to pay 15% of the cost - it appears in our case that there may have been miscommunication (to our advantage) from Hanger and Tricare, where Hanger did not get approval from Tricare but proceeded to collect our 15% responsibility, billed Tricare and was denied and then in turn billed us for the remainder. After some very " heated " phone conversations and an office visit, Tricare determined that we had no patient responsibility and therefore Hanger could not charge us. This may have just been a **lucky** mistake in our favor. > > > > You absolutely can and should appeal. We are in the appeal process with TRICARE right now. > > > > > > Mom to Liam, 8 months > > STARBand since 2/25/09 > > Sent from my Verizon Wireless BlackBerry > > > > Tricare help, PLEASE! > > > > > > Anyone know how Tircare paid for the helmet when it is on the " government no pay " list? I was told that I CAN'T even appeal. > > Help! > > Annie > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2009 Report Share Posted March 23, 2009 We are Prime in the TRICARE North region. You are very lucky that you were able to get that past TRICARE. They were fine with the helmet if we allowed the major surgery to remold Liam's occipital plate, but when the neuro said he would rather try the helmet, they quickly denied coverage. , Mom to Liam, 9 monthsSTARband since 2/25/09Sent from my Verizon Wireless BlackBerryFrom: "mjlewinski" Date: Mon, 23 Mar 2009 04:36:20 -0000<Plagiocephaly >Subject: Re: Tricare help, PLEASE! May I ask...are you Tricare Prime or Standard? My son Aidan wore the Hanger cranial helmet from Oct.-Dec 08. We are TriCare Standard and had to pay 15% of the cost - it appears in our case that there may have been miscommunication (to our advantage) from Hanger and Tricare, where Hanger did not get approval from Tricare but proceeded to collect our 15% responsibility, billed Tricare and was denied and then in turn billed us for the remainder. After some very " heated " phone conversations and an office visit, Tricare determined that we had no patient responsibility and therefore Hanger could not charge us. This may have just been a **lucky** mistake in our favor. > > > > You absolutely can and should appeal. We are in the appeal process with TRICARE right now. > > > > > > Mom to Liam, 8 months > > STARBand since 2/25/09 > > Sent from my Verizon Wireless BlackBerry > > > > Tricare help, PLEASE! > > > > > > Anyone know how Tircare paid for the helmet when it is on the " government no pay " list? I was told that I CAN'T even appeal. > > Help! > > Annie > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2009 Report Share Posted March 23, 2009 Prime. What a great story! Good for you. Annie > > > > > > You absolutely can and should appeal. We are in the appeal process with TRICARE right now. > > > > > > > > > Mom to Liam, 8 months > > > STARBand since 2/25/09 > > > Sent from my Verizon Wireless BlackBerry > > > > > > Tricare help, PLEASE! > > > > > > > > > Anyone know how Tircare paid for the helmet when it is on the " government no pay " list? I was told that I CAN'T even appeal. > > > Help! > > > Annie > > > > > > Quote Link to comment Share on other sites More sharing options...
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