Help with Insurance Company

From: Roger Bledsoe (
Thu Jan 11 15:12:08 2007

Hello! I am a 43 year old male, retired from Active Duty Air Force. In June 1996, I had a laparoscopic nissen fundoplication for GERD. After the surgery, I had difficulty swallowing. In March 1997, they did an open laparotomy to take down the nissen and revised it with a toupee fundoplication. In late 1999, I started experiencing severe abdominal pain. In February 2000, I had exploratory laparotomy to cut out the adhesions. The doctor who performed the surgery in Spokane, Washington, said that the adhesions were so bad in my abdomen that they were spiderwebed throughout my abdomen. He removed as much as he could. The doctor also told my wife and I that in the future, they may have to put Seprafilm around my bowels to prevent the adhesions from adhering to my bowels. I started experiencing severe abdominal pain again 2001. In May 2001, I had exploratory laparotomy where they cut out more adhesions and also found a portion of my bowel twisted and adhering to my incision. In 2003, I started experiencing severe abdominal pain again. After several hospitalizations at Scott Air Force Base and abdominal x-rays and CT scans showing partial small bowel obstruction, I contacted Dr. Redan (in Scranton, PA at the time). Dr. Redan performed laparoscopic surgery in February 2003 in Scranton, PA to cut out the adhesions. He also removed my gall bladder and he had to reconstruct my pyloric sphincter (valve between stomach and small instestines) because the adhesions had wrapped around it and practically closed it. In August 2006, I again started experiencing severe abdominal pain. I have been admitted to Saint Elizabeth's Hospital in Belleville, Illinois three separate times over a six week period of time with severe abdominal pain and partial small bowel obstruction. I asked for a referral to see a surgeon in St. Louis. I saw Dr. Eddy Hsueh at Saint Louis University Hospital and he told me that if it was significantly affecting my quality of life that he would do surgery and he would use Seprafilm that would significantly reduce the adhesions from adhering to my bowels. Dr. Hsueh also told me that the next time that I was experiencing severe abdominal pain to come to the emergency room at Saint Louis University Hospital and he would take care of the problem and not just admit me for 2-3 days and send me back home. I was admitted to Saint Louis University Hospital on December 13, 2007. Dr. Hsueh wanted to do the surgery, but my insurance company (TriCare) disapproved it. I was scheduled for surgery on January 2, 2007, and TriCare dissapproved it again. I appealed the disapproval and they disapproved my appeal. The first time that TriCare disapproved it, they actually accused me of being addicted to pain medications and also mentioned that I have emotional disorders causing the pain. I have since contacted my Congressman and Senators asking them for help. I am in constant severe abdominal pain and just want some relief. I have an appointment on January, 9, 2007, with a gastroentrologist, to see if I can get him to recommend the surgery. Does anyone know of anything else that I can do to get TriCare to pay for the surgery? Thank you very much.

Roger Bledsoe

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