Denied by Tricare........:(

I was denied yesterday by Tri-Care. I'm so disappointed. Has anyone else out there been denied by Tri-Care and then approved on appeal? The doctor is of course appealing it, but I just don't think it's going to happen now. So I'm not getting my hopes up.

I'm so sorry to hear about that. Did they tell you why?? I'm still waiting on my status. Don't give up hope just yet...you never know what could happen. I haven't heard of anyone appealing with Tricare just yet, but I have heard of great success with insurance companies after appeal. Good luck to you!!

They owe you an explanation. Find the reason for denial and go forward from there.

I'm waiting to hear back from the doctor's office as to why they denied me. So I guess we'll go from there. It's just very depressing.

Just call them and ask, it doesn't have to come from your doctor's office.

I wasn't aware that I could question them! Duh!! I'll have to do that when I get home from work. Thank you for the info!

Yeah, they really should have provided verbiage in the denial (which both you and your surgeon's office should have received) that explained why, but this doesn't always happen, unfortunately. Even though they're our policies and we pay for them, it's not unusual (as happened in my case) that the surgeons' office learned of my approval before I did.

Hi, are you a 100lbs overweight? Do you have a co-morbidity? If not, those could me reasons why. Let us know what the doc says.

I got rejected by Tricare, so I went down to Mexico 3 weeks ago and had it done there for $7500.00. Loved my experience and am glad I didn't let my rejection discourage me.
Kari

I guess I jumped the gun. My doctor called Tricare today and the denial was on the first submittal, not on the latest one. They had wanted a little more info after the first one. Tricare said it is still in the pending state. So I'm keeping my fingers crossed but not getting my hopes up.

I hope it gets approved. FWIW...Tricare needed more info from my surgeon as well before they approved it, so maybe that's a good sign!

The waiting for this is killing me!! Does anyone have a link to the Metropolitan weight charts that they go by? I lost the link and I just wanted to look at it again. I am trying not to get my hopes up, because I'm really afraid they will not approve it. I don't know what I will do if they don't. I guess I'll go back to Weight Watchers and try that, again.

Here is a link to the met life charts.
Met life ideal height weight tables references

Just remember, they require you to meet the high end of the suggested weight for your height.

Thanks for the link. Do you know what frame they go by or does the doctor tell them that?

Congrats to you for your band!

I remember my Dr. telling me I was medium framed - BUT I only qualified under 200% as small Frame. I can only assume that my Dr. fudged and said I was small framed.

If it is your surgeon that does it - I am pretty sure he will say you are small framed. They WANT you to have the surgery. However, if you have an unwilling PCM, they may not.

Sorry, I'm not much help on that one.