My primary care physician suspects that I have Fibromylagia and sent in a referral for me to be seen by a Rheumatologist. My nurse case manager denied this referral, as this was not on my initial list of complaints (I did complain of a lot of pain and discomfort since I had multiple orthopedic injuries due to a rocket attack- the pain is all over and not getting better). Anyways, from what I understand, if I do have Fibromyalgia and it is not diagnosed by a Rheumatologist then the Army won't consider it, yet I am not allowed to see a Rheumatologist. Kind of a Catch 22. Any ideas here? Should I just pay for a visit out of my own pocket? If I get to the MEB physical and I show them in the primary care doctors notes that my physician suspects I have Fibromyalgia, and I have proof that I was denied the referral to confirm this, will the MEB let me see a Rheumatoligist?
Referral denied
- Thread starter TJkick
- Start date
First, Why is your nurse case manager denying the referral? Is it due to you going through a MEB? Second, does your PCM think that your condition cause you to be unfit? If he/she does then they should write that in their notes and not necessarily on a profile. As part of the MEB process, if your condition warrants a P3 the MEB doctors will change your profile. When your narrative summary is being finalized, one of the last things they do is update your profile so check your AKO. Also, and most important. When you meet with your MSC for the VA, makes sure you put EVERYTHING on the claim form. if the back is full, they can continue it. DO NOT let them tell that the doctors will review the rest. Whne it goes on the form and you sign it, that is it until the MEB process is done.
As far as the referral, if the NCM does not approve it, go back to your PCM and go to Patient Advocacy. you should not be denied since you are going through MEB.
I am a Military RN and I am half way through the process and did see a specialist while being med boarded.
I hope this helps.
Your case manager should have "zero" input on denial of referrals. Case managers are supposed to be advocates, not adversarial. That's between your PCM, you and the MTF/Tricare. What I recommend is you go to the Tricare management office and find out if your referral was denied and if so, by who.
You need to know who denied it so you can submit it for approval and have a better chance. Just because an MEB/PEB is initiated doesn't preclude appropriate medical care. Look up the patient bill of rights.
Another avenue is contacting the MTF XO, having your Congressman submit an inquiry on your behalf, Patient Advocate and also writing your own personal statement to be given to the Tricare management office and placed in your medical records.
You need to know who denied it so you can submit it for approval and have a better chance. Just because an MEB/PEB is initiated doesn't preclude appropriate medical care. Look up the patient bill of rights.
Another avenue is contacting the MTF XO, having your Congressman submit an inquiry on your behalf, Patient Advocate and also writing your own personal statement to be given to the Tricare management office and placed in your medical records.
I had enough issues and owies, my PCM sent me to get checked. The Rheumatologist said that everyone of my owies are caused my structure issues and not fibromyalgia. which he said was pain without a structure issue ("this joint is messed up, and so is this one, and this one...")
It took two months to see the Doctor and that was going 70+ miles. Everyone that was close to Hill AFB had 4-5 month wait times, and they screened all their referrals. I had to be an ornery-old-SF bubba (or a sweet talker) to be seen. Make sure you get checked. Spend the time now. These things will not go away without help.
Rheumatologists are hard to get into in Utah. Hope you have a better time.