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Old 09-05-2008, 11:26 PM   #6
JWRN
Just smoking poetry
 
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Join Date: Jun 2008
Posts: 608
Blog Entries: 4
State: TN
Re: Tricare has denied me once and again

As most of you know, I was denied at first, resubmitted, and was approved.
Tricare goes by Metlife's ht/wt chart. They use the Medium build frame for the required wt. This is what my denial letter told me. I had the comorbidities, which they accepted (high blood pressure and sleep apnea), but told me that I needed to weigh 227 lbs to be approved (I weighed 220.5). Sooooooooo.....I gained 13 lbs and went to the surgeon's office and they resubmitted the new weight...and I was approved in 2 business days! Remember...you HAVE to weigh that required wt...either 100 lbs over with comorbids or 200% over without. Your denial letter should tell you what you need to get approved. Surely you can SOMEHOW put on the weight.
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Humana (doesn't cover) and Tricare Insurance
Tricare denied! Appealed and reversed!
Surgery September 30th
First fill Nov 5th 1cc (total of 4 cc in band) Highest=233/preop=220/present=163





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