TRICARE and CEC

Newbie Joined: Dec 03, 2005 Posts: 1 Status: **Offline**

Hi! My name is Erica and I just joined this group. This is awesome!! I have been an Endo patient for almost 10 years. I was indirectly diagnosed when I was 16. I was directly diagnosed when I was 19, by having a laparoscopy. My second surgery was in 98. (Both done when I was civilian) I am now trying to have surgery again. My husband is military so choices are limited unless we want to come out of pocket. I just fired a doc I was referred to by TriCare. He wsa heartless, rude, and contradicted himself over a span of TWO whole visits. I have been in contact with CEC. I am trying to get all my records together so I can send them to CEC and get them reviewed. My husband and I have decided that if paying out of pocket will help me, then so be it. I want to get TriCare to get CEC into the network if they aren't already. I spoke to TriCare yesterday adn the lady was not very helpful. She said I needed to go back to my PCM and have him put in a new referral and to note that I want to go to the CEC rather than some doc in this podunk town. That was all the help I could get. My husband comes home from Iraq next month, after being gone a year...we all know what it is like at homecoming time! I was trying to have surgery before he came home because we have "plans".

This disease almost killed my marriage until my husband started doing research with me...even though he is in Iraq. It all but killed our sex life and that was hanging on by a thread. I didn't talk about my disease at all because he has been through a lot with losing his mother to breast cancer among other things. I was scared that if I went back under the knife for Endo they would find something more serious, like cancer. I couldn't bare bringing up the feelings he had when he lost his mom (at age 9). We talk a lot about endo now. He wants to know everything about it to better educate himself and maybe any soldiers who has spouses with it.

Any ideas on how I should approach TriCare about this disease to try and get Endo specialists covered????

Posted: Mon Dec 05, 2005 2:19 am Post subject:

Does your PCM work w/ you at all? I would just try and see if he/she would be willing to try and do a referal to the CEC and see if TriCare would at least cover some of it that way, rather then you paying it all out of pocket. I know before I had a PCM that was great and would write me any referal he could for me. The tough part was the fight w/ the hospital itself proving to them that my care was out of their hands for my last surgery.

A good tip is to do all the research you can as well as proving you have tried what their hospital provides and it didn't work, or that their docs don't do the correct surgeries that have been proven to help. Use your records to help back that up. I had my referal put in then I saw the Patient Rep (which knew me well from complaining legitametly about some of the care I recieved) and I explained the situation to him and he helped walk my referal through the steps for my approval.

Good luck and keep me updated on how it goes. And WOOHOOO about your hubby coming home. Salute