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  #1  
Old 03-29-2017, 11:30 PM
high1988 high1988 is offline
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Join Date: Mar 2017
Posts: 5
Default Tricare

I have recently been disapproved for ADR through Tricare. I was injured while on Active duty. They gave me the option of getting a fusion but I refused due to mobility, recovery time, longevity and the better chance of return to full duty. Does anyone have any suggestion on dealing with appeals for Tricare. Appeals for any insurance company?
Thanks in advance



__________________
2011 diagnosed w/bulging disc L5/S1
2016 diagnosed w/degenerative disc disease L5/S1
Tried steroid injection, PT and medication
Injured on Active Duty
It's time for surgery.
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  #2  
Old 03-30-2017, 02:06 AM
mosullivan86 mosullivan86 is offline
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Join Date: Sep 2016
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Hey High,

I just got surgery approved through Tricare standard (husband is active duty). They approved it first try. Where are you located? DR B's office said I was the first patient that had ADR approved through Tricare for them without a fight, everyone Was very surprised.
__________________
30 year old RN
NOV. 2014- C5-C6 herniation with ridiculopathy
Numbness and tingling in all extremities
1st opinion- Recommended 1 level Fusion- NOPE
2nd opinion-Recommended Mobi-c, Dr had only implanted 5.
3rd opinion- Recommended Mobi-C, not crazy about the guy.
4th opinion: Recommended Mobi-C, Dr Blumenthal

June 6, 2017 C5/C6 Mobi-C disc replacement with Dr. Blumenthal at Texas Back Institute!!



Ready to get back to an active lifestyle!
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  #3  
Old 03-30-2017, 05:20 AM
donmas2000 donmas2000 is offline
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Join Date: Dec 2016
Posts: 58
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Hi high1988, as i thought fusion is gold standard and L5S1 has no much movement on it. L5S1 manly deal with compression on the spine so think fusion on this level will still be ok. As i also has problem on this level and still thinking fusion or ADR on this level. I just afraid about the facets joint problem in the later stage and a revision on it with risk on life. As i meet a guy also choose fusion on L5S1 as he dont want to risk on another operation on the same level. Please let me know what your truth thought on it. As i also know fusion may take more than 6 month to fuse or a year to fully fuse. Cheers
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  #4  
Old 04-03-2017, 10:01 PM
high1988 high1988 is offline
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Join Date: Mar 2017
Posts: 5
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mosullivan86,
My apologizes for the late reply (new to the cite). I am in Augusta GA. I am surprise they didn't give you the run around too. Awesome job. What did you do to get approved?
__________________
2011 diagnosed w/bulging disc L5/S1
2016 diagnosed w/degenerative disc disease L5/S1
Tried steroid injection, PT and medication
Injured on Active Duty
It's time for surgery.
Reply With Quote
  #5  
Old 04-03-2017, 10:18 PM
high1988 high1988 is offline
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Join Date: Mar 2017
Posts: 5
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donmas2000,
I did a lot of research on the difference in the two. While the fusion may be good for some, I prefer the ADR. Several reasons I prefer the ADR for the following reasons "but not limited to":
1- The return to duty is much quicker
2- Average recovery time is quicker
3- It's approved by the FDA
4- It preserve mobility
In addition, I am a marathon runner, I need all the mobility that I can get.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176705
__________________
2011 diagnosed w/bulging disc L5/S1
2016 diagnosed w/degenerative disc disease L5/S1
Tried steroid injection, PT and medication
Injured on Active Duty
It's time for surgery.
Reply With Quote
  #6  
Old 04-10-2017, 01:57 AM
mosullivan86 mosullivan86 is offline
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Join Date: Sep 2016
Posts: 43
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High,

Unsure, I have been dealing with my neck issue for around 3 years. I've done a few rounds of PT, no injections (not interested in that, and Drs say I wouldn't get any relief due to the compression on the spinal cord). Do you know which insurance group covers your region? (Humana, united, etc?) I know Humana has different rules of what they approve than united does. United is who approved my surgery.

I would also recommend calling a tricare liaison or patient advocate at your base. They helped me when I was through standard and just starting with this whole mess.
__________________
30 year old RN
NOV. 2014- C5-C6 herniation with ridiculopathy
Numbness and tingling in all extremities
1st opinion- Recommended 1 level Fusion- NOPE
2nd opinion-Recommended Mobi-c, Dr had only implanted 5.
3rd opinion- Recommended Mobi-C, not crazy about the guy.
4th opinion: Recommended Mobi-C, Dr Blumenthal

June 6, 2017 C5/C6 Mobi-C disc replacement with Dr. Blumenthal at Texas Back Institute!!



Ready to get back to an active lifestyle!
Reply With Quote
  #7  
Old 04-11-2017, 09:53 PM
high1988 high1988 is offline
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Join Date: Mar 2017
Posts: 5
Default

mosullivan86,
We are in the Humana (Tricare South region). It's a shame that different regions have different rules. A Soldier is a Soldier is a Soldier regardless of where they live. I'm in the process of dealing with the patient advocate now. I have submitted all the paperwork and I am waiting on answers. This will be my last stop before contacting my congressman. I don't think they would like that.
__________________
2011 diagnosed w/bulging disc L5/S1
2016 diagnosed w/degenerative disc disease L5/S1
Tried steroid injection, PT and medication
Injured on Active Duty
It's time for surgery.

Last edited by high1988; 04-11-2017 at 09:54 PM. Reason: Plugged in who I was speaking to
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