315 views
1 comment

I must express my total disgust with the Humana Military Authorization for Care/Specialist Referral Systems. I reported to Tampa under the assumptions that everything for my surgery was approved and scheduled with Dr.

Prada on 8.28.2015. Upon my arrival on 8.24.2015 to the Laser Spinal Institute located in Tampa, FL. I completed the rest of my clinical exams needed on 8.25.2015 and they were sent over electronically to Tricare for my Authorization Approval. With a suspected turnaround time of 72 hours, Tricare sent notification that they required more documentation on 8.26.2015 around 4pm before giving approval which pushed back my surgical window by another 24 hours.

The additional documentation was sent over on 8.27.2015 that morning. Which pushed back my approval time another 24 hours. My question is and still why did the nurseโ€™s referral office need additional documentation in the first place. There is no new MRI report the latest report was completed back on 6.8.2015 and the rest of the clinical information was completed on 8.25.2015.

Showing that the neuro-block was successful and I would benefit from this procedure. Looking online Tricare was aware that my surgical procedure was scheduled for 8.28.2015 and no one made it a priority for me to meet that timeline. I wasted time and money as you can see by the attached documents for a procedure that has not been accomplished. I returned back to Jacksonville, FL on 8.30.2015 and waited till Monday 8.31.2015 to still try and receive my authorization for surgery.

I spoke with a Ms. Jacky R. and stated that my authorization was sent to second level review unit for a medical necessity determination review. I requested to speak with Wayne Hurst again, and try to get some results that were unsuccessful.

Instead, I was transferred to a Ms. Janine and she stated that I had to go through the entire process again of speaking with different managers before I could speak with Wayne. I take all this as tactics to discourage me from reaching my desired results for surgery. She later transferred me to an answering machine where I was supposed to leave a message for Wayne.

Wayne did give me a call later and stated that he contacted the second level determination board personnel they stated my file is there for review and that it would take a week to receive an answer. I donโ€™t not understand how both my primary care physician and the Laser Spine physician (Dr. Prada) both says, I need surgery but now I have to wait an addition week for a determination board to determine if I should receive surgery. I request a full review and response sent to me in regard to this and what I can do in the future beside changing my insurance company for this not to happen again.

Also, I understand I was under travel at my own expense.

However, I have traveled and came out of pocket and based on Tricare not meeting the required timeline I still need to return to Tampa and have this procedure done. I feel Tricare need to fund my travel this time go around.

Reason of review: Problems with payment.

Monetary Loss: $700.

Preferred solution: Deliver product or service ordered.

Tricare Cons: To many issues to explain in this forum.

Location: Jacksonville, Florida

Do You Have Something To Say ?
Write a review

Comments

chat-icon

Please avoid publishing any personal information and promotional content

You will be automatically registered on our site. Username and password will be sent to you via email.
Post Comment
Guest

Tricare will fund this but you have to ask for a travel reimbursement letter outside of a 100 mile radius. Then you will then be issued orders like military travel orders.

You must have a start date and completion date.

You have to pay for everything up front but keep every receipt regardless of what it is. I just went through this.

Tricare Reviews

  1. 150 reviews
  2. 56 reviews
  3. 21 reviews
  4. 2 reviews
  5. 2 reviews
Tricare reviews