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military wife with ms

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    military wife with ms

    i am a wife of a soldier and am so grateful for tricare that i was able to receive tysabri at no cost to me. but now we moved and the dr's in texas won't take my documentation. i had been on tysabri for 18months. what do i do?

    #2
    Provided you are still a tricare beneficiary, my advice to you is to contact the "patient advocate" at the military treatment facility for assistance. I ran into a possibly similar problem when I pcs'd from one tricare region (north) to another (south) and was told by new region that my previously approved treatment had to be re-approved. I believe the reason for this (at least that is what I was told) is because the various tricare regions are managed by separate contractors (I.e., humana, united health, etc) and at the time they we operating different versions of the tricare contract and therefore had different rulesets. All that to say...hopefully you can work the system to restore coverage for your prescribed treatment. Good luck.

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      #3
      Hi,
      I'm a military wife with MS too...

      Have you tried calling Biogen to find an approved facility to receive the Tysabri infusions?

      I have tricare standard so if you have prime, I'm not sure how that works except that do whatever you can to switch to standard!! $150 deductible and you can go to any doc you want (that accepts tricare, I have found very few that don't), and you have a continuity of care with no referrals etc.

      First I was told that my Tysabri has no oop and now I see I have a $1000 annual cap which means after the cap is met- basically first infusion meets it- then I pay $0, but it's up to the infusion center if they are going to charge you the diff up to the annual oop cap.

      Hope this isn't confusing you more- I know it's a circus

      Also, I'm on EFMP- doesn't help one bit except that we have a BAH waiver since my husband accepted a PCS out of state and I needed to remain in current location due to my health. (Yeah that's another post)

      anyway, hope calling Biogen directly and switching to tricare standard may help you.

      I am also on permanent disability and chose only Medicare part A since my husband is AD and tricare is waaaaay better for coverage. Just FYI. We are blessed to have these options.

      Prayers to you and your military service- God bless America!

      PS I was on Copaxone for years with no issues, just switched to Tysabri two months ago and get my infusions at a civilian infusion center.
      There is always a rainbow!

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