Re: Tricare~ Our Story

[Guest guest]

Christi,

When are you going to have training pants??? I need some in a big

way. na doesn't fit most because she is like in the 125% for

size! She is 2 1/2, 36 lbs and ~40 " . She loves her diapers so I

have to go cold turkey with her but I want to protect my house

na, 2 1/2 DOC Grad Feb 04

Kiersten, 7 months, DOC band 1/10/06, Tort

www.thefilyaws.com

> > >

> > > hi! Im Christi, my daughter Mya was evaluated at our Army

> hospital

> > > and we were told she had plagio and tort. SHe was referred to

a

> > > craniofacial plastic surgeon for an evaluation who also

> confirmed

> > > severe plagio and moderate tort. He then sent us to Cranial

> Tech.

> > > This is when we found out that Tricare would cover the visit

to

> the

> > > craniofacial plastic surgeon but would not cover the band our

> > > daughter needed. We were angered by this. But the amount of

> time it

> > > took us to get all of the visits done leading up to the

cranial

> tech

> > > visit we felt we were wasting time. Mya was already 8 months

old

> so

> > > we went ahead with the casting knowing Tricare would deny us.

We

> > > never got our first denial letter. They say they sent it but

we

> > > never got it. We requested a copy of what was covered. They

said

> > > they sent it we never got it. This frustrated us. Without that

> > > denial letter we could not file an appeal so we decided to try

> > > another route. We had been told that almost all appeals filed

> are

> > > denied anyway. From that point on we did everything we could

to

> BUG

> > > Tricare to death. We contacted state representatives,

> congressmen,

> > > etc.(who contacted Tricare on our behalf) We also contacted

the

> army

> > > hospitals IG who also made calls to tricare. We contacted the

> > > Hospitals commander who then got the chief of pediatrics of

the

> > > hospital involved and she started making calls. During all of

> this

> > > my husband and I were both calling Tricare and making visits

to

> the

> > > tricare office DAILY! The people in the office knew us by

name!

> > > Every time we called or went there our story was the same..

our

> > > complaint was the same. But we had them look stuff up give us

> more

> > > numbers etc. I had Generals wives calling me asking what they

> could

> > > do to help which all I told them was CALL! Having all these

> people

> > > call Tricare on our behalf is what I believe helped us get

> approved.

> > > Mya was born with this condition. Her plagio was congenital

not

> > > positional as Tricares policy stated (not sure if it has

changed

> > > now) We pushed that issue but hadnt gotten anywhere with it.

> Finally

> > > in july 2002 (mya was banded in march2002)we called Tricare

like

> we

> > > normally did and they told me a check had been issued to

Cranial

> > > tech. I was Like WHAT?? I called cranial tech to confirm. They

> said

> > > yes and that they were issuing me a refund check for the

amount

> we

> > > had paid so far. I was in shock! Then in aug mya required a

> second

> > > band. I went ahead with the banding.. Tricare denied us. It

only

> > > took around 5 calls with me telling them look you paid for the

> first

> > > one theres no way you can deny a continuation of a treatment

you

> > > have already paid for. SO they paid. After that I found out

that

> > > anything approved by tricare that requires you to drive more

> then

> > > 100 miles the military will reimburse you for your expenses.

> So.. we

> > > then filed paperwork on that. They paid us back for ALL of my

> gas,

> > > All of our food, and my hotel stays on the days we went for

her

> > > first fittings.

> > > Anyway.. I cant say ours was a conventional approach. But this

> is

> > > what we did and this is what worked for us. I do beleive we

> Bugged

> > > Tricare to death and that is why they paid. There is no other

> reason

> > > i can see that they wouldve paid out of no where. We at no

time

> > > filed ANY formal appeals.

> > > If you have any more questions please feel free to email me at

> > > Thezepps6 @ nc.rr.com (without spaces)

> > >

> > > Christi <><

> > > www.littlebeandiapers.com

> > >

> >

>