What do you think of my health care insurance problem?

I have full coverage from 2 health care insurance companies: “First Choice Health” and “TRICARE”.

In June of 2010 I had a $81K procedure (ablation) performed on my heart to make it beat normally. This procedure was hugely successful as it has cured me of a heart arrhythmia that I had suffered with for 9 years.

7 months after the ablation TRICARE informed me that it would pay zero amount and I may appeal yet gave no reason for the denial of the claim. So I submitted a 2 page very detailed appeal explaining why I needed the ablation.

TRICARE’s response to my appeal was that they didn’t receive adequate information about the ablation. So I sent TRICARE the information they requested.

TRICARE’s latest response is that “First Choice Health’s” payment $42,253.19 is more than the TRICARE allowed payment and therefore the service is considered paid in full.

I think that it is reasonable to think that TRICARE is responsible to pay at least as much as “First Choice Health” is paying. Am I wrong?

What do you think?

What would you do next if you were in my shoes?