Tricare - Women Veteran's
 

I am another Tricare recipient and have been denied for a multi-level cervical artificial disc and a lumbar Artificial disc. Tricare claims they will only cover one cervical ADR and not multi-levels. They also claim that the lumbar ADR is on the no pay list. I have appealed and they continued to deny. I sent in my packet yesterday for outside agency to review and consider but now I am regretting it as I just got on this forum last night. I am pretty sure it will be denied again as I only submitted evidence based practices showing that multi-level and lumbar ADR are not experimental and they have a higher success rate that fusion.

Today, I am submitting a package to the VA asking them to pay for the three ADR's since they are all service-related and I am rated 80 percent disabled from the VA. I am hoping they will approve the expense but I doubt it. I will keep you posted as I try to be positive.

Babe,

This link may be helpful. It reports that a US insurance carrier was court ordered to pay for a multilevel ADR because that carrier had failed to prove that the procedure was experimental.

Good luck, Jeff

Thank you so much JSS. I will send an addendum letter to the second level and ask them to add this to my appeal. I will keep everyone posted.

Thank you JSS I truly believe the link you sent me helped me tremendously in winning my third appeal. Thank you, Thank you, thank you!