Question:
Good evening sir. I served in the Army as a 68X Behavioral Health Tech. During this time i sustained an injury to my spine which resulted in me having to go through an MEB (Medical Evaluation Board) as I could no longer lift more than 25 lbs. Fast forward 8 years later, multiple doctors including VA specialists, telling me it was all in my head, I found a spine specialist in Chattanooga, TN who did an MRI, X-Rays and clearly saw an issue with my spine. I had an annular tear in my L4-L5 Disc. At this point we opted for an artificial replacement. At one point during the recovery, it had failed. Tricare did approve and pay for the surgery. They approved for the 2nd surgery that was an attempt to replace the device with a newer more stable device. This failed due to severe adhesions on my main arteries running down my leg. As the attempt to manipulate and repair the issue it had started bleeding again. Since this incident happened they decided to back out of the surgery. The doctor then decided that we could wait for the back fusion for a later date or do it while I was in the hospital. Myself I wanted it done as soon as possible, so I opted to have it done later on the next week while still in the hospital. The fusion is done and I am home and I get a letter in the mail from Tricare that includes DD-FORM 2527 to see if a third party is reliable to pay the hospital and surgery bills. My issue is this. Tricare accepted both surgeries and now I feel like they are wanting to back out of paying for them. This injury is service connected. I feel like I am now left with 4 scars and a mass of debt due to them not wanting pay, in which i feel i should be covered. What should I do?
Jim's Reply:
The communications that you received from Tricare will include instructions for an appeal of any denied payments or services. However, it doesn't sound as if you're at that point yet. For now you should simple follow any instructions you're given and if you are denied a benefit, then you appeal.