Author Topic: Military (Active/Separated/Retired), and TRICARE (Life/Standard/Remote/ Life)  (Read 57322 times)

lori67

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Hi Anne!

I had my BAHA paid for by Tricare, so you shouldn't have a problem with that, but you already know about the hoop-jumping required!  They're good at that.

I just switched to Standard because I was told I could not go to a doctor in town, I had to go to the Tricare Prime clinic.  I appealed their decision and was denied.  I could appeal again, but it would go through the same people again, so it's probably not worth the effort.  They just don't seem to get the whole concept of wanting one doctor to oversee all of my medical care.  They say they get it and they assign me a primary care physician at the clinic, but I've never met her, never requested her and don't even know anything about her.  Aside from the fact that you see someone different every time you go anyway so the whole primary care manager thing seems to just be on paper.  I am glad that you've had better luck with Prime.

I'm in Virginia too - near Oceana.  If you're nearby maybe we can get together and compare scars over a cup of coffee!   Or we can meet GM in Portsmouth!   ;D

Lori
Right 3cm AN diagnosed 1/2007.  Translab resection 2/20/07 by Dr. David Kaylie and Dr. Karl Hampf at Baptist Hospital in Nashville.  R side deafness, facial nerve paralysis.  Tarsorraphy and tear duct cauterization 5/2007.  BAHA implant 11/8/07. 7-12 nerve jump 9/26/08.

GM

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Anne,

Welcome fellow Virginian!  Wow...great experience with TRICARE!  Since we have a "unique" type of health insurance, any experience is helpful. 

I'm up for coffee!
Originally 1.8cm (left ear)...Swelled to 2.1 cm...and holding after GK treatment (Nov 2003)
Gamma Knife University of Virginia  http://www.medicine.virginia.edu/clinical/departments/neurosurgery/gammaknife/home-page
Note: Riverside Hospital in Newport News Virginia now has GK!!

WetEver

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Lori,  How did you get TriCare to pay for the BAHA?  I have been denied.  My doctor and Cochlear have both filed appeals on my behalf and still waiting to hear on that.  I have a temp surgery date of 07DEC and hoping and praying it comes thru in time.  Believe it or not, I have never even been to Portsmouth Naval.  All my medical needs have been met and approved by TriCare thru my primary care physician.  And they approved my AN surgery out of state!  I just hope they come through on the BAHA.  Coffee sounds excellent!!!!

lori67

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My audiologist said that Tricare typically denies the BAHA the first time around, but they approve it when you appeal.  The way my doctors deal with them is to just send all the documentation and the letter of medical necessity on the first request ( I guess that's what they usually ask for in order to process the appeal).  I would imagine it's less work for them in the long run (the doctor, that is, not Tricare, as they seem to enjoy making more work for themselves).

I'm sure the person who does the insurance at your doctor's office already knows this, but make sure it's coded as a prosthetic and not a traditional hearing aid - there's a completely different code.

I will tell you that it took over a year to get Tricare to pay the hospital after my BAHA surgery due to a coding error by the medical records department and the inability of anyone to admit that they could have possibly made a mistake.  It was a year of passing the buck and finally took a phone call to the hospital administrator to straighten it out.  Tricare paid the doctor and paid for the processor, but didn't pay the hospital, so I was getting the bill.  I mean, come on, lets be logical here - do they think I had the surgery in the parking lot or something?  Anyway, it was all eventually paid for but not without the typical aggravation I have come to expect with Tricare.

Portsmouth Naval is actually a really nice hospital, just hard to get an appointment sometimes due to the volume of patients they have.  Good coffee though!!

Lori
Right 3cm AN diagnosed 1/2007.  Translab resection 2/20/07 by Dr. David Kaylie and Dr. Karl Hampf at Baptist Hospital in Nashville.  R side deafness, facial nerve paralysis.  Tarsorraphy and tear duct cauterization 5/2007.  BAHA implant 11/8/07. 7-12 nerve jump 9/26/08.

Rc Moser

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I retired AF.  I had trycare (try and they don't try that hard IMO!) I didn't like it so I got Mailhandler's 15 years ago beings I work as a federal Civilian employee.  One day I will probably have to go back on trycare.  I was not diagnosed while I was in the Military but I did have it, far as I can remember my first symptom was in 1987 with a droopy left eye lid. yep I had hearing loss But this was before the WWW, they just keep readjusting my base line. I was in a career field that required hearing tests every year and beings I was around LOUD jet engines I just figured it was normal. Got stiffed at three different bases. Course after I get out the migraines started and my hearing kept getting worse and 7 years later the big AN was discovered. 

I can't believe how much medical costs has gone up in the last 6 years. When I had my first MRI it costs $2200 I thought that was outrageous. Well, guess what Had one two months ago and it was $3400 now.  my Hernia operation cost $48,000. and I wasn't in the day clinic 4 hours.  My AN cost in 2003 $214,000.  I don't want to know what one cost now? IMO insurance is mostly not the bad guy, it's the risen costs that got to be controlled. It the Fed's want to control something they need to do that IMO by establishing a rate of charge that both parties have to except.

 
9/17/03, 4.5CM, Translab, OU Medical Center, Dr. (the ear man) Saunders and Dr. B. (the BrainMAN) Wilson  along with about 4 other Doctors that keep me going for 18 hours.

lori67

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RC -

Had to laugh at your Trycare comment!  I told my husband they call it Trycare because they're trying to kill me with their care!   :D

My husband has the same issues with his annual hearing tests - they just keep readjusting his baseline.  That's helpful.  He's not the one with the AN or the SSD, but there are times I'm sure his hearing is worse than mine.  Or maybe it's his listening that's worse than mine....   ::)

Lori
Right 3cm AN diagnosed 1/2007.  Translab resection 2/20/07 by Dr. David Kaylie and Dr. Karl Hampf at Baptist Hospital in Nashville.  R side deafness, facial nerve paralysis.  Tarsorraphy and tear duct cauterization 5/2007.  BAHA implant 11/8/07. 7-12 nerve jump 9/26/08.

GM

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I'm just trying to keep this thread open for active/Separated/Retired militarey and TRICARE (Life/Standard/Remote) Insurance patients.

Anyone with recent instances that we can share for those of us that are military/post military?

GM
Originally 1.8cm (left ear)...Swelled to 2.1 cm...and holding after GK treatment (Nov 2003)
Gamma Knife University of Virginia  http://www.medicine.virginia.edu/clinical/departments/neurosurgery/gammaknife/home-page
Note: Riverside Hospital in Newport News Virginia now has GK!!

GM

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TRICARE is now on Facebook!  I joined the group yesterday.  What's good about this is that we can get immediate feedback from TRICARE, keep up on new items/issues, and contact with MANY fellow service members that are dealing with TRICARE!!!

http://www.facebook.com/TRICARE

Be well all...

Gary
Originally 1.8cm (left ear)...Swelled to 2.1 cm...and holding after GK treatment (Nov 2003)
Gamma Knife University of Virginia  http://www.medicine.virginia.edu/clinical/departments/neurosurgery/gammaknife/home-page
Note: Riverside Hospital in Newport News Virginia now has GK!!

lori67

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That's great to know, Gary.

Thanks for sharing that.  I'm going to check that out.

Lori
Right 3cm AN diagnosed 1/2007.  Translab resection 2/20/07 by Dr. David Kaylie and Dr. Karl Hampf at Baptist Hospital in Nashville.  R side deafness, facial nerve paralysis.  Tarsorraphy and tear duct cauterization 5/2007.  BAHA implant 11/8/07. 7-12 nerve jump 9/26/08.

Paul F

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Gary

Somehow I have missed this thread in the past.  Here is my experience.  I am retired Navy and my primary care physician was at the Balboa Naval Hospital in San Diego.  My wife kept complaining that I was loosing my hearing so I set up an appointment to have the tests.  The doctor decided after the tests that he could help my lose with a stepedectomy.  He performed the surgery there at Balboa and, for some reason, the operation failed and I ended up SSD on the left side.  Needless to say, I did not opt for the same surgery on right side.  They gave me the option of a bi-cros aid or BAHA.  I knew nothing about BAHA and elected to go with the bi-cros.  What a pain that was with the wires going around the back of the head.  Shortly after that, I turned 65 and Tricare Prime dropped me and so did Balboa.  I now had Tricare for Life (TFL).  My primary insurance now is Medicare with TFL secondary. 

I was very unhappy with the bi-cros and did research on the BAHA.  I made an appointment with a doctor in Portland, OR and was told I was eligible for the BAHA and the Medicare covered everything.  I have had the BAHA for a year now but have now registered it with the VA because they determined my hearing loss was service related.  The VA provides the batteries for my Intenso as well as insurance.

My biggest concern is finding a Primary Care Physician that takes Medicare.  Hard to find sometimes in rural areas.

Paul

john j

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Not sure if my tale fits into this thread, but I'd like to tell all you ex-military types that this morning I picked up a brand new TransEar at the Milwaukee VA Hospital.  My AN surgery was performed in 1969 by Air Force MD's, so the VA accepts responsibility for my audio care.  I first heard of TransEar last year - on this forum, in fact - and immediately contacted the VA.  So, long story short, 41 years after going under the knife, I'm spending the day taking my new ear for a test drive, driving my wife nuts and cruising around the house listening for what I've been missing all these years.  It's an odd experience and the TransEar is a strange (and uncomfortable) little device, but amidst all the whistles tweets and hoots caused by my constantly messing with something alien stuffed into my ear canal, I believe I'm hearing a dial tone on my left side for the first time in 4 decades.  I don't know what it cost the taxpayers, but I'm forever thankful.
John
AN surgery Jan 1969, Wilford Hall Air Force Hosp, Lackland AFB, TX

leapyrtwins

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John -

this is incredible.  A TransEar after 41 years of being SSD!  Amazing!

I'm so glad you are getting good results with it.

It's my theory that if there's something you can do to help with your SSD, you should go for it.

You're a perfect example of that!

Congrats,

Jan
Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways

Paul F

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John

The VA also performs the BAHA procedure at some locations.

Paul

GM

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John,

Thats great news about the transear!  Thanks for posting!
Originally 1.8cm (left ear)...Swelled to 2.1 cm...and holding after GK treatment (Nov 2003)
Gamma Knife University of Virginia  http://www.medicine.virginia.edu/clinical/departments/neurosurgery/gammaknife/home-page
Note: Riverside Hospital in Newport News Virginia now has GK!!

moe

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John,
Congratulations, after 40 years! See the journey is never ending.
Interesting info, thanks for sharing.
Maureen
I was going to have my surgery at Wilford Hall in summer 06 but the wait was sooooo long, what with the war and all.
Ended up having it at Madigan in Tacoma, WA, (where husband was at the time) and then some follow up eye procedures at Wilford.
BIG Place.
06/06-Translab 3x2.5 vascular L AN- MAMC,Tacoma WA
Facial nerve cut,reanastomosed.Tarsorrhaphy
11/06. Gold weight,tarsorrhaphy reversed
01/08- nerve transposition-(12/7) UW Hospital, Seattle
5/13/10 Gracilis flap surgery UW for smile restoration :)
11/10/10 BAHA 2/23/11 brow lift/canthoplasty

 


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