Denied By Tricare Prime due to PCP

Feb 01, 2011

Si I got a call this morning from Dr. Adams Surgery Scheduler letting me know I was denied for the surgery because apparently my PCP put the wrong diagnostic code when they submitted the original referral for the doctor. They put it for Upper respiratory instead of Morbid Obesity. So Tricare denied it as they didnt know why I wanted Gatsric for a chest problem. Tricare also stated that the PCP apparently had tried to fix it by resubmitting it immediately after and Portsmouth Naval Medical Center overode the procedure for assignment  to them. Only problem is they have a 3 year wait for the surgery. So I called my PCP and they are resubmitting the referral again for the correct doctor (who I already have done the testing with), and as long as Tricare approves the new referral, then the Surgical scheduler will resubmit my paperwork. So hopefully my tentaive date of 21 Feb will still be good.

0 Comments