31 July 2014

Pithy bitters

There is probably an inverse theorem somewhere which accurately calculates how much one loves the military relative to how much one is dissatisfied with the medical administration of retired personnel.

I had my last approved physical therapy visit today; TriCare has disapproved any continued treatment because "the beneficiary has been in physical therapy for the past 2 [sic] years", "the beneficiary is able to exercise per her own program" and as there is "no new functional loss for which a rehabilitation goal has been established, maintenance therapy and exercises for strength and endurance is excluded from coverage, and the beneficiary has had ample time to learn strengthening exercises, conditions for coverage are not met and the request is denied."
Working on releasing scar adhesions with pressure point therapy;
the ultrasound is not G-rated, so no photos of that! 
Basically, because I can exercise on my own, I must have no need for treatment. The insurance company is completely disregarding the pain management aspect as well as the fact that the purpose of my current PT is the use of electro-laser and ultrasound to break up the abdominal adhesions caused by my daily activities (this was true even before I was able to start running again, which wasn't until last October).

I think I speak for everyone who has on-going rehab/therapy - if I didn't need to go, I most certainly would prefer not to.....I am now going through appeals process to try and get the visits covered; if not, I will be paying out of pocket. That's just how it is; I have gone several times without treatment for several weeks and the end result is significant pain in both my abdomen and back, misalignment and more adhesions.

As I finish this, I have just gotten off the phone with the TriCare call center. So, in addition to submitting an appeal, my PCM also needs to resubmit to try and get approval for treatment using a different diagnosis code. The best line "well, do you know if it's a 625.9 diagnosis code or a 789.00 diagnosis code?" Ummm...no, I don't really, 'cause that's a clinical/medical thing and I didn't make that analysis. Sigh....

Oh, well. These are just the little thorns on the roses of my life. Nonetheless, grateful they bloom in the sun and smell sweetly in the summer air, just have to figure out how not to get stuck, right?


2 comments:

  1. I'm sorry you have to deal with the headache of all of this! My husband didn't run into this problem with his rehab from injury but I often run into issues with my own care with Tricare so I know how frustrating it can be! I hope you can get the care you need and don't have to pay out of pocket. Good job with all you've been doing for the fund!

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    Replies
    1. Thank you, Kara. I am waiting to see if the new referral is approved, cross your fingers!

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