TennCare

has anyone had the problem with JohnDeere not paying the full cost but only paying for half, leaving you to make a change to another.....

I don't have John Deere, Dr.s in the Eastern side of TN won't accept it, but will accept Blue Care, so I had to have my changed when I was accepted by TNCare. I just found out that Medicare may not pay for mine since I don't have 5 years of supervised diet programs. Blue Care won't pay for mine completely because Medicare is my primary. Also it's hard to find a Dr. who will accept just Blue Care for the surgery. But I wish you luck in your journey. Kathy

BlueCare is what I have and yes on my own it was hard to find a surgeon that would take it but once I got a case manager with the ins. it was a rather smooth road from there. I really don't know much about John Deere though. Sorry. I've had to fight to keep BlueCare as my MCO they keep wanting to switch me to PHP. However the PCP Ive seen for yrs and the CNM I see do not take PHP so I fight them tooth and nail everytime they try to change my MCO. So far Ive been rather lucky. Also I'm not quite understanding how any of the TNCare MCO's could approve you for the surgery but only cover half. From what my case manager told me if you prove medical nesesity for the procedure then the Tncare MCO will cover it. All of it. If the medical nesesity isn't proven then they deny approval. Not quite sure how they can go wishy washy on it for ya. However if they do hand down such a decision ask for an appeal on the decision. If they deny on the appeal tell them you want your day before an admistrative judge. Most of the time it won't get that far but it just might. Wishing you the best of luck. *huggles*