Tricare

[kekipivill]

Does anyone have any experience receiving approval from Tricare for HR?

[HowieF-16]

I am a TRICARE PRIME for Retirees patient and saw Dr. Raterman in Tampa on Friday, 12 Nov 2013.  I discussed this situation with his NP and Surgery Coordinator and both assured me that they have performed a HR on many TRICARE PRIME and STANDARD patients.  I will follow up when we have actual approval.  My surgery is scheduled for January 8, 2014.

[HowieF-16]

On Friday, 27 Dec 2013, I received notification that TRICARE will pay for my hip resurfacing with Dr. Raterman in Tampa, FL.  Due to the large military presence, active and retired, in the Tampa area, Dr. Raterman's office is experienced in obtaining approval with TRICARE.  A definite plus.  Surgery scheduled for Jan 8, 2014. 

[bigc130]

TRICARE just denied my THP (15 Oct, 2014) based upon it was not a covered benefit. My research shows that a policy revision in 2012 excluded specifically hip replacement due to degenerative disease. (CHAMPVA POLICY MANUAL, Transmittal #130, 8.1.2012, Chap 2 Sec19.1,Exclusions, R.) Does anyone else have this issue to deal with? and how can we fight it. My surgery was scheduled for 11.17.2014, Cleveland Clinic, Dr. Brooks. How can I move forward?

[rickrefs]

I received a BHR at Portsmouth Naval Hospital on 11 May 2015.  I also have an appeal submitted to Aurora and has gone to DoD Policy to change the TRICARE coverage for all TRICARE beneficiaries.  The hip resurfacing procedure is currently not covered for Active Duty or any other beneficiaries, yet one surgeon is performing the procedure.  Dr. Ed Lambert has done between 50-100 BHR--he is not sure how many he has done, but I assure you he is competent and has performed near 1000 THR.  Despite what the TRICARE contractors will tell you, you can be seen out of your catchment area by Dr. (CMDR) Lambert.  Contact me if you have questions. 

I am two weeks post op and the pain is gone and walked about half mile today along with exercises. 

VR

Rick