There is an appeals process for this. My neighbor is a Tri Care Rep I have left a message for her to call me on this. I am sorry that I have not noticed your post sooner. Nothing is impossible and you MUST not take no for an answer. I honestly do not think that this is a no win situation for you. One thing you may have to do is temporarily transfer your pcm to San Antonio. This will mean that you go to your local tricare office and switch. Then you get your present PCM to transfer records to the new PCM and then contact the new one and have your referral along with the records transferred to that area. We do this when my step son comes to the east from the west so that he can be seen on base. Find out if this neurosergeon is in the network for San Antonio...oh shoot just call me. 301-743-7359 or 301-848-6102. I will help in anyway i can. I have been in a situation where tri care said no and even in the final determination said no but in review it was reversed and the process was not long a drawn out. But quick movement is essential...I will pull all resources I have to help.