Under Waiver Review - CIV Team Referral or MTF for Required Medical AMI

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hopefulmominva

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DD is under waiver review (YAY) but she just sent me her AMI and it states that she can either use a CIV subcontracted physician or test facility OR complete the medical AMI at a MTF. The CIV team hasn't received notice from DoDMERB so they can't tell her if there's a subcontractor in our area at this time (it can take up to 72 hours). If they don't have one, it can take up to 30 days for them to find one for her. Of course, DD is anxious and wants to get the appointment scheduled ASAP. For those of you with experience here, would you recommend we wait and see what the CIV team says or go ahead and look for something at a MTF? She needs to see a pulmonologist regarding asthma and they're asking for methacholine challenge test and inhalation bronchial challenge test. I can take her to a private provider but I'm afraid they'll slow the process down as they may not be as knowledgeable with the SA requirements. Thanks in advance!
 
We did the exact same test at our local Childrens Hospital. We tried to go the route of using who they recommended but they could not find any offices to do the work withing a 1 Hour drive of us. We got in and out of our local Hospital and had everything turned into Dodmerb withing three weeks.
 
We are in this process for ROTC for the same thing. My son was notified of the Dodmets provider in the area (still 2 hours away) within a few days of being notified of the AMI. I don't think you are going to have any luck with MTF. If you go private you'll have to pay for it yourself unless her primary care MD can send a referral, in which case your insurance may cover it. Some places I spoke with wouldn't event schedule without an order, even if we were paying out of pocket. ( I was quoted $350-$500 for Dr. appointment, $250ish for one PFT and one place wanted an X-ray on top of that even though Dodmerb didn't ask for that) You also want to be sure they are familiar with exactly what the Military is asking for. We elected to go with the Dodmets provider, got the PFT done pretty quickly, (can be done ahead of Pulmonologist consult) appointment for Pulmonologist was several weeks out, but the private Physicians in our area were about the same time out. Getting records has been a tedious process to, so if she has to collect those, have her get going on that asap. This has been our experience so far.
 
Ryder70 said:
We did the exact same test at our local Childrens Hospital. We tried to go the route of using who they recommended but they could not find any offices to do the work withing a 1 Hour drive of us. We got in and out of our local Hospital and had everything turned into Dodmerb withing three weeks.
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@Ryder70, thank you so much for sharing your experience. I've emailed my daughter's primary physician to see if we can get a referral to a pulmonologist as we wait to see what the CIV team can provide. I hope that you DD/DS received a waiver!
 
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EJF said:
We are in this process for ROTC for the same thing. My son was notified of the Dodmets provider in the area (still 2 hours away) within a few days of being notified of the AMI. I don't think you are going to have any luck with MTF. If you go private you'll have to pay for it yourself unless her primary care MD can send a referral, in which case your insurance may cover it. Some places I spoke with wouldn't event schedule without an order, even if we were paying out of pocket. ( I was quoted $350-$500 for Dr. appointment, $250ish for one PFT and one place wanted an X-ray on top of that even though Dodmerb didn't ask for that) You also want to be sure they are familiar with exactly what the Military is asking for. We elected to go with the Dodmets provider, got the PFT done pretty quickly, (can be done ahead of Pulmonologist consult) appointment for Pulmonologist was several weeks out, but the private Physicians in our area were about the same time out. Getting records has been a tedious process to, so if she has to collect those, have her get going on that asap. This has been our experience so far.
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@EJF, thank you! So you were sent to two separate facilities? I really don't mind the drive. DD, like all other applicants, has worked so hard to get to this point. The least I can do is drive her to the best place, even if it's hours away. We live in the DC/MD/VA area so I can't imagine CIV not having a subcontracted pulmonologist within an hour or two.
 
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hopefulmominva said:
@EJF, thank you! So you were sent to two separate facilities? I really don't mind the drive. DD, like all other applicants, has worked so hard to get to this point. The least I can do is drive her to the best place, even if it's hours away. We live in the DC/MD/VA area so I can't imagine CIV not having a subcontracted pulmonologist within an hour or two.
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So my son is going to the same place, he just decided to go ahead and get the testing done first because they were able to do that sooner, the pulmonologist appointment was about a month later. Without going into all the reasons, he just felt better getting the actual tests done as soon as possible. They offered to do both on the same day at the same place. I’m sure you’ll have pretty good luck getting in somewhere there.
 
Pursue any and all options - you can always cancel one at the last second if your preferred option comes up first. Referrals, pre-appointments, testing, results, follow-up appointments, etc....it can be a long time from start to finish unfortunately. Don't give up --- if things don't work out with timing on AMI, keep in mind one can always re-apply for next cycle, and then they will be well ahead of the curve. It can be extremely difficult for the applicant when they are faced with waiting for the next application cycle, but in the end, it'll be worth it. Best of Luck !!
 
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Thank you all! DD's pediatrician has contacted the pulmonology department and hopes to have a referral for her soon. The Required Medical AMI hasn't been uploaded to dodmets so we'll keep checking but the CIV Team won't be able to assist until the letter is available to them. I just hope that our private provider will respond with the required codes because I don't understand what the difference is between these two, other than 242.06 is required for proper billing through the Concorde contract...what does that mean?

R242.03 --- REQUIRES A PHYSICIAN'S APPOINTMENT: Please obtain a methacholine challenge test performed by a board certified Allergist or Pulmonologist to rule out bronchial hyperactivity, and provide the printouts of FVC, FEV1, FEV1/FVC, FEF 25-75% as well as the flow volume loops in accordance with American Thoracic Society guidelines. Provide a written interpretation of the results.

R242.06 --- REQUIRES A PHYSICIAN'S APPOINTMENT: Please obtain a methacholine challenge test performed by a board certified Allergist or Pulmonologist. This remedial code is in addition to the remedial code of R242.03 and is required for proper billing through the Concorde contract.

It really stinks that it all comes down to timing and it's all out of your control!
 
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hopefulmominva said:
Thank you all! DD's pediatrician has contacted the pulmonology department and hopes to have a referral for her soon. The Required Medical AMI hasn't been uploaded to dodmets so we'll keep checking but the CIV Team won't be able to assist until the letter is available to them. I just hope that our private provider will respond with the required codes because I don't understand what the difference is between these two, other than 242.06 is required for proper billing through the Concorde contract...what does that mean?

R242.03 --- REQUIRES A PHYSICIAN'S APPOINTMENT: Please obtain a methacholine challenge test performed by a board certified Allergist or Pulmonologist to rule out bronchial hyperactivity, and provide the printouts of FVC, FEV1, FEV1/FVC, FEF 25-75% as well as the flow volume loops in accordance with American Thoracic Society guidelines. Provide a written interpretation of the results.

R242.06 --- REQUIRES A PHYSICIAN'S APPOINTMENT: Please obtain a methacholine challenge test performed by a board certified Allergist or Pulmonologist. This remedial code is in addition to the remedial code of R242.03 and is required for proper billing through the Concorde contract.

It really stinks that it all comes down to timing and it's all out of your control!
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I feel your pain. If she hasn't seen anything from the CIV team after the 72 hours, she can always email her DoDMERB technician and check on the status. I agree with making appointments and canceling if need be, but I would not get any testing done, or appointments until you know exactly what they are requesting. She can clarify with CIV or DodMerb if it's not clear.
 
EJF said:
I feel your pain. If she hasn't seen anything from the CIV team after the 72 hours, she can always email her DoDMERB technician and check on the status. I agree with making appointments and canceling if need be, but I would not get any testing done, or appointments until you know exactly what they are requesting. She can clarify with CIV or DodMerb if it's not clear.
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DD's dodmets portal updated this afternoon (guess we're just being a little too antsy)! YAY! the CIV Team now has the USNA's Required Medical AMI so hopefully, they'll have providers listed soon. I feel like we're all in this crazy race against time!
 
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