Tricare has denied me once and again

Thread Starter  

Hi All!
Tricare denied me the first time and I appealed. I just went on to Triwest and saw that I wasn't approved again. Bummer! Really saddens me and it's horrible that I have to gain more weight just to get approved. I want to wish everyone the BEST OF LUCK through their WLS! I'll just have to figure out what I can do next.

Unhappy in AZ

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Insurance: Tricare Prime
PCM: April 22, 2008
Consultation: May 14, 2008
Psych Eval: June 3, 2008
Sleep Study: June 28, 2008
Approval: July 7, 2008
Surgery: ???

What was there reason for denial? It seems like you jumped thru the hoops with all the tests, so it looks like the docs thought you were a candidate. Don't lose hope though - many people were denied multiply times. I even believe there are threads for letters of appeal. Keep trying!

Good luck.

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I just got denied today too, what was the reason for the denial?

I'm over 100 lbs overweight and I have sleep apnea, which I think is a comorbid..

I'm soooo upset.

Thread Starter  

I do not know why as of yet. Sorry that you were denied. Is it the first time? If so, make sure you appeal. You can have your PCM help you out. Best of luck!

__________________
Insurance: Tricare Prime
PCM: April 22, 2008
Consultation: May 14, 2008
Psych Eval: June 3, 2008
Sleep Study: June 28, 2008
Approval: July 7, 2008
Surgery: ???

I too wonder did you ques why the denial. I would say to these companies. Do you want to insure me 10 yrs from now when I may or may not have more medical issues than now that I may never have if I had this surgery. The squeeky wheel gets oil. I say fight hard.

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Only when we are no longer afraid do we begin to live.
Surgery 9/30
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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=178

Yes, this is the first time I was denied. I don't think I need to gain weight, because I am 5'6 253. I think they didn't get my sleep apnea thing in time..

I'm getting LAP-BAND^®, and Tricare is paying for it:)

I just submited my appeal today with lots of help from JWRN with my new weight of 245lb and 5'5". Wish me luck guys. I'm not really confident since I did not get my doctor to say I'm diabetic.
Keep trying. Hope you get it.

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PCM letter,PSY eval,Nut eval,Surgeon appt,Blood tests and sleep study:
paperwork submited to Tricare 09/11
DENIED: 08/20/08
Appeal sent: 09/09/08
NOT APPROVED: 10/27/2008

You have GOT to get approved!! I am praying hard for ya!

__________________
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=178

Do you have a comorbidity?

I have High cholesterol(not comorb) and a very bad accid reflux desease(not considered eather) and high blood sugar but I'm not diabetic. My chances are almost 0, I guess.

__________________
PCM letter,PSY eval,Nut eval,Surgeon appt,Blood tests and sleep study:
paperwork submited to Tricare 09/11
DENIED: 08/20/08
Appeal sent: 09/09/08
NOT APPROVED: 10/27/2008