I had authorized surgery on 3 Feb 12 where my civilian Dr had removed cartilage cells from my rt knee patella femoral joint which were then sent to a lab to be multiplied. The second surgery, where my new cells were to be implanted back into my knee, was scheduled for April 6, 12. After a month and a half of battling with TRICARE, they(I should say an RN) have denied the second surgery. i have damage to a certain area of the knee which is not FDA approved and damage that is FDA approved as well, my dr was requesting authorization to repair the approved areas, not the non-approved area. TRICARE mis-interpreted his request and denied the whole surgery. When my Dr. called to clarify, he asked to have a peer-to-peer discussion with the medical director tied to TRICARE who "supposedly" denied his request; my Dr. was denied the discussion and contact info for the medical director. He then asked me if i could call. I was denied the information as well eventhough i stated that I am legally entitled to any information regarding my case and if the medical director was the one handling my case, I was entitled to his/her contact information as well. The RN stated that she would get fired if she gave that information and so I asked her why? Her statement is as follows "If we gave out the medical director's contact information, she would have people like you calling her everyday!" I asked this RN if it was wrong for a beneficiary to call everyday to check the status of his or her claim? Her response was "Yes, you and your dr's office and [other un-named parties] bother me everyday, it's not going to help your case." This RN even threatened to call my Commander if i continued to call and request medical information regarding my case. At this point, I have emailed my state's Attorney General and Senators and am waiting for a repsonse.
Any suggestions/advice are welcome and appreciated. Thank you
Any suggestions/advice are welcome and appreciated. Thank you