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Thread: Appealing a Tricare denial

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    andreacn's Avatar
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    #1

    Appealing a Tricare denial

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    How do you do that? I got just a letter saying they will not pay for a service I need to get done in order for surgery. I don't understand anything the paper says on how I can appeal.
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    #2
    This is just a question might not help at all.
    But, do you have other health insurance?
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    #3
    Quote Originally Posted by Tana Bear View Post
    This is just a question might not help at all.
    But, do you have other health insurance?
    Nope. Im beginning to think I should just pay outta pocket for what I need.
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    #4
    Talk to the benefits manager, or call tricare and have them explain what needs to be done to get it approved. It may of been how the doctor put the request in and they need to re-submit.
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    #5
    Quote Originally Posted by andreacn View Post
    Nope. Im beginning to think I should just pay outta pocket for what I need.
    Ok I was just asking, because I remember I got all of my approvials denied because I had another health insurance on record.

    I would either call tricare or go down to the tricare office (if it is close by) and talk to them about it.

    Does it say why they are denying you?
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    #6
    It should say why. I've had stuff denied because it was coded wrong. But I'm on standard so it was already done and I just had to stay on it.
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    #7
    What is the procedure? Is it something tricare covers?
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    #8
    Yea If you know it is something that Tricare covers call Tricare and ask with it was denied. Ask them to explain your EOB. When they look at it they will be able to help you on your particular situation. It may be that the providers office coded the request incorrectly which means they need to resubmit the claim.
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    #9
    Quote Originally Posted by Pixi7272 View Post
    Yea If you know it is something that Tricare covers call Tricare and ask with it was denied. Ask them to explain your EOB. When they look at it they will be able to help you on your particular situation. It may be that the providers office coded the request incorrectly which means they need to resubmit the claim.
    yeah, we had to do that but then something happened and we got assigned a case manager. after they resubmitted it it was approved.

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