Re: Help with Insurance Company
From: Marie (mom4041@aol.com)
Thu Mar 15 18:47:48 2007
At Thu, 11 Jan 2007, Roger Bledsoe wrote:
>
>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.
>
>--
>Roger Bledsoe
>
--
I had adhesions removed back in 1993 while stationed in Germany.
It all went well. It did take almost 8 months and a trip to
Walter Reed hospital and Landstuhl for the military to agree to do it but
my relief was great. Now they are back I believe due to having a
sigmoidectomy
last year after a perforated colon due to diverticulitis. I have been
suffering
for about 6 months and have found a doctor whom I trust willing to do
the surgery but your posting makes me wonder will TRICARE approve it.
Please tell me how this all worked out for you....thank you