SGT. SHAFT: Woman who had leg surgery gets confusing info about TRICARE health insurance

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Dear Sgt. Shaft:

On Saturday, July 20, at 7 p.m., my 18-year-old son accidentally plowed into me while I was standing at the top of a two-stair entrance with a wooden floor in my house. I landed, fracturing both lower bones of my left leg, including shoving the larger bone away from the knee bone. … I was first taken to Fair Oaks Hospital, then transported (4 hours later) to Fairfax Hospital.

At about 5:30 a.m. Sunday, July 21, the junior orthopedic doctor said my leg needed surgery, but that we needed to wait 10 days for the swelling to go down. He wrapped my leg in cotton and then cast it in a large cast. I was sent home by car.

In some future time, I would like to inform hospital personnel about giving family members a bit more info on patient care and also providing the correct medical equipment when they are sent home.

The next day, the surgeon handling my case called and asked how I was doing. I told him I was in a lot of pain. We talked about the cast, and he told me to come right back in and he would fix me up with a nuts-and-bolts thing. The next morning, I had surgery and I woke up to this metal bar, nuts-and-bolt contraption that keeps my leg from bending and doesn’t hurt like the cast did. About 2½ days later with PT training on how to get around with the proper wheeled walker that I did not have before and how to hop up or down a step to get inside my home, I was ready to leave.

With a family member at my side for safety, I waited for the swelling to go down. I got TRICARE approval for the surgery from July 22 in the mail. (TRICARE is the health care program serving uniformed service members, retirees and their families worldwide.)

Yesterday, on Aug. 1, the office of the surgeon called and said TRICARE did not approve the surgery. They were told that I was supposed to get a referral through my doctor’s office beforehand. I did not know of this. I was in pain and a bit loopy from pain meds. They did not require this of the first surgery, which was the first I can remember ever having.

My husband called to establish an emergency referral. He had to bring paperwork to the doctor (8:30 a.m. Aug. 1) and we still have not heard from TRICARE. The surgery has been rescheduled for 9 a.m. Wednesday, Aug. 7.

Thank you for your time.

Debbie J.
Burke VA

Dear Debbie:

I referred your TRICARE issue to Jim Schwartz, TRICARE for Life Priority benefits administrator, and he assured me that he would resolve this bureaucratic mess.

Shaft notes

• In response to President Obama’s Executive Order, the Departments of Defense (DoD) and Veterans Affairs (VA) highlighted recently the establishment of two joint research consortia, at a combined investment of $107 million to research the diagnosis and treatment of post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) over a five-year period.

“VA is proud to join with its partners in the federal government and the academic community to support the president’s vision and invest in research that could lead to innovative, new treatments for TBI and PTSD,” Secretary of Veterans Affairs Eric K. Shinseki said. “We must do all we can to deliver the high-quality care our Service members and Veterans have earned and deserve.”

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