[josepentia]

On the off chance that any of your have Tricare- I have a situation and could use your advice, and if you do not have Tricare, I could use your input as well!

I had a completely successful left sided A/VTOS surgery in Tucson, AZ in spring '11. I planned my pregnancy well and had my little girl in spring 2012 and had planned on having surgery for the right side in the summer of '12. However, it so happens that my surgeon did a mission in the middle east for 10 months and by the time he returned, I was moving to Omaha, NE.

I've been here in Nebraska since February. I saw my PCM (who's a quack) and he "rellunctantly at best" wrote me a referral to see a cardiothoracic dr in Omaha. Saw that specialist, who was nice but he doesn't do the decompression surgery- says that I'm a "once in a career type of patient" and hasn't before seen anyone with my condition bilaterally. He is sending me to ANOTHER cardiothoracic dr who "might be able to perform your surgery." BTW, I was sent to YET AGAIN have a CT scan/venogram/arteriogram which of course showed sever compression on my right side necessitating surgery. DUH.

So, my issue is this: There isn't a competent surgeon up here in Omaha. My PCM hardly even believes the testing and my diagnosis and previous surgery. He will not petition (write a referral) to Tricare to request that I go back to Tucson, AZ and have the original surgeon do my right side. My original surgeon, is IN NETWORK and a COVERED provider, mind you. My PCM won't do it. I cannot seem to make any headway up here, I have GOT to find a work around! I believe that Tricare will cover my surgery by the surgeon in Tucson- they just need to get a damn request from a physician. !!!!!!

What is your recommendation? How do I get my PCM on board? How do I get SOMEONE to write a damn referral to get me back to AZ since there isn't a surgeon up here who does the surgery???

What have you experienced? What do you suggest? What is some "crafty" wording to use?

TIA!

[Jomar]

Can you find another PCM?
One that will connect/contact the AZ surgeon and work with them on getting approval?

Or contact the AZ surgeon and ask about any help from their office?
Maybe they know of a helpful dr or how to got about getting approval?

[josepentia]

my PCM is a military dr- and I can switch to another PCM with "some difficulty" but will be assigned to another military PCM that is partnered with the original one. Does that make sense? So if it's not bad enough that the original PCM has his "opinion" notes in my health record for everyone to see, I would assigned to his "partner/associate" as well. I am still looking into getting the approval to switch anyway.

I have contacted the surgeons office in Tucson. My original surgeon wrote a note (full page) that is permanently included in my chart and he sent it to my email so that I have it for my record as well. The surgeon clearly states what my diagnosis is, what testing/procedures I have had done, my surgery and successful outcome, that his office managed my care (follow up AND regarding my right side) and that I will need to have surgery on the right side. He expressed in the note that he would be willing to do the surgery and provide any help necessary.

HOWEVER. His office manager/nurse is the most unhelpful person in the USA. She doesn't return phone calls or emails and she acts like I'm a complete bother to her. The original surgeons' office MIGHT be able to request from Tricare themselves that I come back for surgery- they certainly can try. I have been trying to get the office manager/nurse to understand that concept. It's been since last Monday since I've heard from her...

What else can we come up with? There's got to be a way to get this done!!