TRICARE Benefit Expands to Cover New Hip Surgery
DoD News, Defense Media Activity
WASHINGTON December 4, 2015 - Starting in January 2016, TRICARE beneficiaries with a diagnosis and referral will be eligible for surgical treatment of a hip condition called femoroacetabular impingement, or FAI, according to a TRICARE news release issued today.
The FAI surgery is the first treatment to be evaluated and approved under the 2015 National Defense Authorization Act's provisional coverage program, which allows TRICARE to provide coverage for emerging treatments and technologies, the release said.
The hip condition can occur when the bones of the hip are abnormally shaped and therefore rub against each other and cause damage to the joint, the release said. Symptoms include pain in the hip or groin area, which limits or hinders mobility, the release added.
Starting on Jan. 1, 2016, eligible beneficiaries with FAI will be able to get the surgery from any TRICARE-authorized orthopedic surgeon. Costs will vary by plan [ http://www.tricare.mil/Costs.aspx?source=GovDelivery ], the release said, but will be lower when using network providers. The surgery must be pre-authorized by the beneficiary's regional contractor, which lets providers present additional information for review by TRICARE and its contract partners. There is no retroactive preauthorization or coverage prior to Jan. 1, 2016.
The release referenced information from the American Orthopaedic Society for Sports Medicine, which explained that some people may have FAI their entire lives and never have any problems. However, if symptoms develop, the TRICARE release said, it usually means there is damage to the cartilage, and the condition is likely to worsen.
"TRICARE can now review emerging health care products and services that are not currently covered under the TRICARE program but may provide a benefit to patients under a provisional coverage status," Dr. James Black, medical director for the clinical support division of the Defense Health Agency, said in the release. "We will evaluate other emerging treatments and technologies for consideration and make public announcements when additional ones are approved."
TRICARE Provisional Coverage Program [ http://tricare.mil/Plans/SpecialPrograms/ProvisionalCoverage.aspx?source=GovDelivery ]
Defense Health Agency [ http://www.health.mil/dha?source=GovDelivery ]