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Old 07-26-2010, 08:39 PM
Abarco Abarco is offline
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Join Date: Jul 2010
Posts: 9
Default Triwest cervical ADR denied

Hi everyone,

I was wondering if anyone had any help, guidance, or approvals for ADR from Tricare? I received my denial letter on Friday and sent in the below letter for reconsideration

26 July 2010
TriWest Health Care Alliance
Reconsideration Department
PO BOX 86508
Phoenix, AZ 85080


To Whom it May Concern:

I am writing to request a formal appeal of the rejected proposed
treatment, cervical disc arthroplasty, for the following diagnosis:
* Cervical Disc Degeneration
* Chronic pain to neck and to right scapular region
* Chronic Muscle spasms to neck and to right scapular region
* Nerve Palsy to right upper shoulder and arm
* Cervical Radiculopathy
* Spondyloarthropaty of cervical spine
* Loss of normal lordotic curvatrure of the cervical spine
* Mild disc desiccation
* Headaches
All of my above listed medical diagnosis are documented with associated
numerous tests that I have been put through since approximately 2007.
Sadly, I have attempted and failed numerous rounds of conservative
treatment only to live in constant pain and always scared and guarded to
not have an acute spasm which feels like I have been struck by lightning
in the back of my neck. This is also affecting my career because of the
numerous medications and vigorous expectations that are demanded by my
profession. I can no longer work as an emergency-trauma Registered
Nurse Specialist. I am currently in graduate school for Acute Care
Nurse Practitioner but with my chronic neck problems this could shatter
my dream, as well. At my age a fusion would literally put me on the
"bench" forever. I have three young children that I would love to
conquer adventures with. With a fusion there would be serious
limitations. I have tried soft c-collars, trigger point injections,
Chinese acupressure, Chinese acupuncture, cupping, tens-unit, moist
heat, cold therapy, cervical pillows, tempur-pedic bed, physical
therapy, professional massage, chiropractic adjustments, freezing and
stretching with ethyl chloride, prednisone, NSAIDS, narcotics, lyrica,
neurontin, muscle relaxers, the Felix trigger point board, cervical
epidural injections, facet injections and ultra sound therapy. I have
literally spent thousands of dollars and have exhausted every possible
remedy to relieve this horrible condition so that I can start living my
life like I used to. Dr. Briggs, my neurosurgeon from the Springfield
Neurological and Spine Institute, Dr. M. Akhtar Choudhary (my
neurologist) and I have all agreed that the cervical disc arthroplasty
is the most appropriate treatment for my condition and that I DO meet
criteria for disc arthroplasty and should undergo this surgical
procedure. Please find the attached documentation that may be helpful
in your
reconsideration of the pre-authorization claim for benefits and payments
in which Tri-Care does cover for all Active Duty Soldiers, but is sadly
denying their dependants of this medical necessity:
* A copy of "not approved" letter
* Medical Justifications for cervical disc arthroplasty
* Clinical literature on disc arthroplasty
* A letter from my doctor
* Cost benefit analysis reports
* FDA approval letter for the prestige ADR

Thank you for your consideration of this much needed coverage . If there
are any questions please contact me at 573-847-8246

Angela M. Barco RN, BSN

I thank you in advance of guidance as to what else I can do? I am so tired of suffering....
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