ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > Insurance Hell

Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


Reply
 
Thread Tools
  #1  
Old 01-27-2012, 01:27 PM
wardbro2's Avatar
wardbro2 wardbro2 is offline
Junior Member
 
Join Date: Jan 2012
Posts: 2
Question Appealing Tricare for C5-C6 ADR - significant atrophy - time is short

I am so glad to find you all. In researching data for my TriCare appeal, I found this great forum. Thanks to everyone. I'm sending in my donation today!
My Situation and Request: I'm an airline pilot, but also AF Reserve officer for over 28 years. I am on TriCare (Reserve Select). I was denied cervical arthroplasty on Dec 29, 2011 because it is still considered "experimental". My neurosurgeon tells me (as well as Medtronics) that TriCare approves this procedure for Active duty members at military hospitals.

DOES ANYONE HAVE ANY INFORMATION ABOUT WHICH MILITARY HOSPITALS AND MILITARY SURGEONS PERFORM THIS PROCEDURE?

I feel that my best shot at winning an appeal is to demonstrate that if TriCare approves of this procedure for one segment of their patient population, they cannot consider ADR experimental and unavailable for another segment. Any thoughts?

My short background: Symptoms began Nov 18, 2011 (deep chest pains radiating out to right shoulder). Cardiologist (echo-stress), PCP (CT scan)... all good. Dec 9 MRI confirms C5-C6 herniation (DDD). Pain so bad I was on too many meds and still not sleeping. Pain has dropped way off the past week, and after 50 days of many meds, I am off them all (and never again I hope - withdrawal was terrible). Pain and numbness still there, but tolerable. Big concern: As a serious triathlete (52 y.o. and looking for something fun to do) I like the advantages of ADR (Prestige is what I would get). Oct 1, 2011 I got 2nd place overall in big triathlon - best shape of the past 25 years. Now, right should is skin on bone. Rt shoulder very unstable do to imbalance of muscle and no sign of improving - numbness on right shoulder remains. (Same goes for my right forearm). Both areas are where my pain has been the most intense. Doctors are very concerned about my risk of long-term damage and have moved from staunch advocates of my ADR appeal to pushing for timely operation (even if it is fusion). Thankful my pain is tolerable for now, but working full-time on my appeal and not quite ready to give up.
Your comments are helpful and encouraging. Thanks!
Reply With Quote
Reply

Bookmarks

Tags
cervical adr, military hospitals, military surgeons, prestige artificial disc, tri-care appeal

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
BC Denial - Appealing - PLEASE HELP Laura C The Big File 8 05-01-2011 07:50 PM
Short term disability? TheFerrell Insurance Hell 2 09-26-2010 12:23 AM
My Story (short version) Julaine The Big File 7 05-19-2005 09:50 AM


All times are GMT -4. The time now is 05:31 PM.


© Copyright 2006-2023 ADRSupport.org All rights reserved.