I just had knee surgery yesterday, and am chilling on my couch with the snazzy cold water pad pump my doc's office had sent to me for recovery. I'm currently serving in an area that is not around any big Navy hospital, just a small AF base for my MTF, so I've been working through all the hoops of referrals to outside providers, etc.
One hiccup I've recently encountered is the authorization my orthopedist put in for my cold pad with circulating pump (code E0218) was denied by TriCare last Wednesday. Problem is, the item arrived last Thursday and I had no idea it was denied until yesterday (I guess I could've done my HW and checked). Being a "medical anything" device, and not a rental, it's not returnable.
I chatted with United Healthcare about it and they said my provider has to do a "Peer to Peer Review" with them about it. After some more searching, these devices are apparently addressed in the TriCare policy manual, and I attached the page from it here. Apparently Tricare thinks the machine's a waste of money ($150-200), and I should hobble over to the fridge every half hour to change my ice out.
Anyone have any experience with this and with getting this covered, say through this peer to peer review thing or with the authorization appeals process? Are the rental types of machines covered? In that case, I could've probably told my orthopedist that and they'd have hooked me up with that.
Either way - watch out for this if you have any orthopedic surgery coming up outside an MTF.
One hiccup I've recently encountered is the authorization my orthopedist put in for my cold pad with circulating pump (code E0218) was denied by TriCare last Wednesday. Problem is, the item arrived last Thursday and I had no idea it was denied until yesterday (I guess I could've done my HW and checked). Being a "medical anything" device, and not a rental, it's not returnable.
I chatted with United Healthcare about it and they said my provider has to do a "Peer to Peer Review" with them about it. After some more searching, these devices are apparently addressed in the TriCare policy manual, and I attached the page from it here. Apparently Tricare thinks the machine's a waste of money ($150-200), and I should hobble over to the fridge every half hour to change my ice out.
Anyone have any experience with this and with getting this covered, say through this peer to peer review thing or with the authorization appeals process? Are the rental types of machines covered? In that case, I could've probably told my orthopedist that and they'd have hooked me up with that.
Either way - watch out for this if you have any orthopedic surgery coming up outside an MTF.