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scentedgal

LAP-BAND Patients
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Everything posted by scentedgal

  1. scentedgal

    Tricare Prime....Triwest issues

    I started backwards. I actually searched the name of the Dr. I wanted thru the Triwest services website. But if you are Triwest like me, you can copy and paste this link on your browser and search for providers in your area http://triwest.com/unauth/apps/OnlineProviderDirectory/default.aspx I'd recommend you register and activate an account if you are a beneficiary, as you can view your referral's etc.. faster than just be waiting on the mail to bring you the letters... Hope this helps! Good Luck!
  2. scentedgal

    Ideas for tricare appeal

    Thanks "Navywif99" ! I'll definetly need all of that ! ) About the referrals.. you'll definetly need it for your consultations, etc.. but not for the seminar. But make sure before you see the surgeon (at the consultation) you bring your referral from the PCM other wise.. Tricare wont pay for it.. It took me like 3-4 days to get it, without counting the days I had to wait to see the PCM ) hehehe Good luck ! and hope all works out for you too!
  3. scentedgal

    Ideas for tricare appeal

    Thanks "Navywif99" ! Still working on it ! I dont think you need a referral for the seminar. But you'll definetly need one from your PCM for your 1st consultation with the surgeon otherwise the insurance wont pay for it. After that, you'll probably need to see the psychiatrist for a pre-op evaluation (you'll need a referral from your PCM too), and after the psychiatrist submits your evaluation to the surgeon, the surgeon will submit all the packet (PCMto Triwest and see if they'll approve your surgery. At least that's how it went with me.. it might be diff. .. dont know.. But good luck with the journey !! )
  4. ok.. so my insurance did not approve my surgery, but today.. I'll start my appeal process! wish me luck !

  5. scentedgal

    Ideas for tricare appeal

    Can someone help out on ideas on what to put on my appeal ? I am frustrated, as my LAP-Band procedure was denied by Tri-west today! I did the "scavanger hunt" (PCM referral for consultation and seminar, attended the seminar, met with my surgeon, met with the psychiatrist, etc.. everyone approved for me to get my lap band surgery - except TRIWEST). I sort of know that you either are 200% over your ideal weight, or weigh over 100 lbs plus have 1 morbid disease.. (HBP, Diabetes, etc.) to be approved for the procedure. I am 100+lbs overweight, and with no co-morbid diseases.. However, I had Gestational Diabetes back in 2009 and had my gallbladder removed back in 2005. Have a family history of HBP, Heart attack, diabetes (granparents), and my dad actually has type 2 Diabetes. I've had anxiety attacks in the past, but other than that.. .. that's it. Any suggestions on what to submit on my appeal ??? Referrals?? etc.. ?? I'd really apprecciate it..! Am frustrated and heartbroken! :S 2 months of doing all this .. to get a no..

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