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Thread: Special Needs Child and TriWest and ECHO

  1. Fresh Newbie
    cimara05's Avatar
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    #1

    Mad Special Needs Child and TriWest and ECHO

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    My husband has been in the military for a long time and I have never ran into the issues I am running into now dealing with healthcare.

    In Feb. of this year, we were sent from OCONUS to a CONUS location due to a enlarged heart on an ultrasound of our unborn child. Since I have been here I have had billing issues, referral issues, and payment issues from TriWest.

    Our baby girl was born in April, she was taken early to deal with the heart issue. This issue is still not resolved and she is now on oxygen full time and a monitor for her oxygen levels. No one had been helping us until I had a chance run in with the special needs person here on the base. She told me we could have a case manager and be on the ECHO program. This program is at an additional cost and provides more services to a child with special needs. We were all for it and enrolled in the program. (Here is where the drama starts people.)

    The special needs rep offered us respite care. This was a blessing since the area we were sent has no family support for us here. Our baby turns gray, drops oxygen saturation, and now is starting to not feed. So for two days we had this nurse come in at night and help monitor her. It was a blessing! Then I get a call from the nursing program stating that care may not be covered. I called the special needs rep and she stated the nursing people should have gotten authorization. The ECHO rep called me and stated that the auth was put in and may not be approved because her issues need to be a little more "worse" then what they are. Today I have found out we were denied for this reason only. (His words!)

    I am at a loss. I didnt mention that we were in TLF from Feb till June. So now that I no longer am getting the help unpacking is out. The ECHO rep suggested that we try to EFMP to a location with family or a humanitarian assignment. (I am guessing that he is unfamiliar with how this works since we were EFMP here and they will not do that again to be close to family. Also that for a humanitarian assignment that the issue needs to be resolved with in a year and the doctors STILL do not know what is really going on.)

    If anyone has ever worked with ECHO or TriWest ANY advice would be helpful since I am about ready to give up on the whole thing and just wing it.

    Thanks
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    #2
    No clue. I switched to Tricare Standard when I started having issues with referrals. The only denial I ever got was because of something miscoded. I'm really sorry you're having so many issues. Have you tried patient advocacy? Does the branch your in have a special needs coordinator? Can you talk to a social worker somehow?
  3. You are here.
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    #3
    We have a 12 year old son on ECHO (Autism and ADHD) and we really haven't had any issues with the treatment his PCM at Offutt had. Have you tried the webrings for Tricare? its called the stomp webring. I know a few military members have had to go through a few assessments and calling the right people on that list to get special medical treatments for their kids. They may be able to assist you better.
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    #4
    No advice, but wanted to offer GL

    *~*Two Hearts, One Love*~*
  5. "If you don't like my attitude, quit talking to me"
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    #5
    Keep plugging at it.
    Get the info ECHO received, its possible they have received a wrong diagnosis. Make sure ECHO has been informed by the correct people as to her condition.

    Have you talked to her PCM/Pediatrician, have you talked to TriWest to see what is available. I have found that there is so much available to us that Tricare is not even aware of. You just have to keep bugging them until you get the answers you want. Detailed answers not just Yeses or Nos.

    I know many people on ECHO and such for special needs children. You have to find out if her condition is considered special needs or something else. EFMP will move you again if it is deemed where they placed you is not suitable for your child. Since you were preggo with her when you got sent there they may not have known what services she would need. Call EFMP as well to see what options you have.

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