After 2 days of trying to get through to the second level review I finally got a call back late yesterday afternoon. It seems that Tricare contracts out to a "reviewing" company to make determinations if what my doctor has determined is necessary is appropriate treatment. This supposed "ortho expert" honed in on the fact that I have rhuematoid arthritis as the primary cause of my knee deterioration and determined I haven't been treated aggressively enough for RA and thus the revision is no medically necessary, welcome to healthcare run by the government...
The nurse I talked to said I had two appeals and if both are denied that is it. I asked if she has ever seen a joint replacement go through both appeals and be turned down and the person left with a non funtioning body part. She said all the time.
After a night of "kicking trashcans" I've decided to fight back. I am going to go the Freedom of Information route and asking for the specifics of the contract of the reviewers to see what their qualifications are and also to see if there are any incentives for saving money by "preventing unnecessary procedures". I'll be doing this at the same time I submit my first appeal.