tricare/pcm is confusing the crap out of me. please help.

[mackQuin]

 My son who is 6 went for a routine eye exam recently. They found a problem with his eyes and the eye doctor wants him to see a specialist. According to the eye doctor's staff they make the appt. for the specialist, tricare told me i needed a referral from his primary physician and i can't just go to a eye specialist. Which i knew, however his primary doc doesn't want to make the referral, she says that since she didn't find the problem she can't make it and according to her that since his vision is 20/20 she doesn't see a issue that warrants a trip to a eye specialist. (when looking up or to the side with his eyes, they don't line up, one eye goes up way further than the other one, and sometimes the right eye won't do anything. The exam he had showed that he has double vision when doing that, and the eye doctor said it was a range of motion issue with his eyes). I obtained the records from the eye doctor and gave them to her and she still seems to think he does not need a referral.

I am so confused. WTF do i do? The eye doctor said that even  though his vision is perfect without further review there is no telling what this could do to his eyes and it needs to be looked into further just to be sure its nothing major.

I"m so confused. Whats the point in doing a routine eye exam every year if you find yourself stuck between a insurance and pcm mess when something is found to be wrong?

..

[I.R.Rachel]

Change your PCM. Call Tri-Care, explain this, and see what other PCMs are available. Sometimes, rarely, but I've gotten lucky, Tri-Care will help with the referral process without PCM help because the eye doctor has recommended the specialist. 

[lwalker270]

Quoting KelissaMaye:

If my dentist could write me a referral to see an oral surgeon, then the eye doctor should be able to write a referral. Do you have a local tricare or referrals office? I would go speak with them instead of calling. Half the time the people on the phone just don't want to be bothered.

Maybe they've changed it since MetLife took over the contract, by when it was UC I had to go through my PCM for a referral to an oral surgeon per Tricare.

[KelissaMaye]

This was at the beginning of last year. I haven't been to the dentist since metlife took over. =\ lol. I dunno.

Quoting lwalker270:

[Noy0323]

We had a similar issue with my daughter. Call tricare and tell them what's going on and if they start telling you the whole "you have to file this and that, sugar honey ice tea"stuff just switch his PCM some doctors are just stubborn! Good luck.(:

[Briyawna]

I only know my PCMs name (if its even the same person) no clue where they are located. But this is why I myself do not go to the doctor unless I am pregnant! Tricare is nice as far as not having to pay for anything, but, I'd rather pay some and go to a Dr that can actually do their job!