Hello! I am a 43 year old male, retired from Active Duty Air Force. In
June 1996, I had a laparoscopic nissen fundoplication for GERD. After
the surgery, I had difficulty swallowing. In March 1997, they did an
open laparotomy to take down the nissen and revised it with a toupee
fundoplication. In late 1999, I started experiencing severe abdominal
pain. In February 2000, I had exploratory laparotomy to cut out the
adhesions. The doctor who performed the surgery in Spokane, Washington,
said that the adhesions were so bad in my abdomen that they were
spiderwebed throughout my abdomen. He removed as much as he could. The
doctor also told my wife and I that in the future, they may have to put
Seprafilm around my bowels to prevent the adhesions from adhering to my
bowels. I started experiencing severe abdominal pain again 2001. In
May 2001, I had exploratory laparotomy where they cut out more adhesions
and also found a portion of my bowel twisted and adhering to my
incision. In 2003, I started experiencing severe abdominal pain again.
After several hospitalizations at Scott Air Force Base and abdominal
x-rays and CT scans showing partial small bowel obstruction, I contacted
Dr. Redan (in Scranton, PA at the time). Dr. Redan performed
laparoscopic surgery in February 2003 in Scranton, PA to cut out the
adhesions. He also removed my gall bladder and he had to reconstruct my
pyloric sphincter (valve between stomach and small instestines) because
the adhesions had wrapped around it and practically closed it. In
August 2006, I again started experiencing severe abdominal pain. I have
been admitted to Saint Elizabeth's Hospital in Belleville, Illinois
three separate times over a six week period of time with severe
abdominal pain and partial small bowel obstruction. I asked for a
referral to see a surgeon in St. Louis. I saw Dr. Eddy Hsueh at Saint
Louis University Hospital and he told me that if it was significantly
affecting my quality of life that he would do surgery and he would use
Seprafilm that would significantly reduce the adhesions from adhering to
my bowels. Dr. Hsueh also told me that the next time that I was
experiencing severe abdominal pain to come to the emergency room at
Saint Louis University Hospital and he would take care of the problem
and not just admit me for 2-3 days and send me back home. I was
admitted to Saint Louis University Hospital on December 13, 2007. Dr.
Hsueh wanted to do the surgery, but my insurance company (TriCare)
disapproved it. I was scheduled for surgery on January 2, 2007, and
TriCare dissapproved it again. I appealed the disapproval and they
disapproved my appeal. The first time that TriCare disapproved it, they
actually accused me of being addicted to pain medications and also
mentioned that I have emotional disorders causing the pain. I have
since contacted my Congressman and Senators asking them for help. I am
in constant severe abdominal pain and just want some relief. I have an
appointment on January, 9, 2007, with a gastroentrologist, to see if I
can get him to recommend the surgery. Does anyone know of anything else
that I can do to get TriCare to pay for the surgery? Thank you very
much.