My audiologist said that Tricare typically denies the BAHA the first time around, but they approve it when you appeal. The way my doctors deal with them is to just send all the documentation and the letter of medical necessity on the first request ( I guess that's what they usually ask for in order to process the appeal). I would imagine it's less work for them in the long run (the doctor, that is, not Tricare, as they seem to enjoy making more work for themselves).
I'm sure the person who does the insurance at your doctor's office already knows this, but make sure it's coded as a prosthetic and not a traditional hearing aid - there's a completely different code.
I will tell you that it took over a year to get Tricare to pay the hospital after my BAHA surgery due to a coding error by the medical records department and the inability of anyone to admit that they could have possibly made a mistake. It was a year of passing the buck and finally took a phone call to the hospital administrator to straighten it out. Tricare paid the doctor and paid for the processor, but didn't pay the hospital, so I was getting the bill. I mean, come on, lets be logical here - do they think I had the surgery in the parking lot or something? Anyway, it was all eventually paid for but not without the typical aggravation I have come to expect with Tricare.
Portsmouth Naval is actually a really nice hospital, just hard to get an appointment sometimes due to the volume of patients they have. Good coffee though!!
Lori
