The 2015 National Defense Authorization Act created a provisional coverage program that allows TRICARE to provide coverage for emerging treatments and technologies.
The first treatment to be evaluated and approved under this new program is surgical treatment of a hip condition called Femoroacetabular Impingement (FAI). FAI can occur when the bones of the hip are abnormally shaped.
Because they do not fit together perfectly, the hip bones rub against each other and cause damage to the joint. Symptoms include pain in the hip or groin area which limits or hinders mobility.
Provisional coverage for FAI surgery began Jan. 1.
Now your healthcare provider can give you a referral for treatment if you are diagnosed with this condition and meet certain clinical criteria. You will be able to get FAI surgery from any TRICARE authorized orthopedic surgeon who performs this procedure.
Your costs will vary by plan, but will be lower if you use a network provider. The surgery must be pre-authorized by your regional contractor. Pre-authorization lets your provider present additional information so TRICARE and our contract partners can make an individual review of your care. There is no retroactive preauthorization or coverage. (Source: Shift Colors | Navy Casualty Office | Winter-Spring 2016)
Cataract removal is one of the most common operations performed in the United States. According to the National Eye Institute, it also is one of the safest and most effective types of surgery.
In about 90 percent of cases, people who have cataract surgery have better vision afterward. TRICARE covers cataract surgery and related supplies and services.
More specifically, TRICARE covers the standard intraocular lens (IOL), a fixed lens designed to target vision at a single focal point.
During cataract surgery, the natural clouded lens is removed and then replaced by an IOL to become a permanent part of your eye. This provides good distance vision but patients typically need glasses for near and intermediate tasks such as reading and computer use.
TRICARE also covers one pair of eyeglasses or contact lenses as a prosthetic device after each medically necessary cataract surgery where an IOL is inserted. If you would like a non-standard IOL instead of a standard monofocal IOL, you will be responsible for the difference in the charges.
For more information, contact your regional contractor (http://www.tricare.mil/ContactUs/CallUs. aspx) or visit the Eye Surgery and Treatment page on the TRICARE website at http://www.tricare.mil/CoveredServices/IsItCovered/EyeSurgeryTreatment.aspx. (Source: Shift Colors | Navy Casualty Office | Winter-Spring 2016)
Thomas Crisp is a retired military officer from Whitmire. His veterans updates can be found weekly in The Newberry Observer.