KarinaM

Meggie, I hope you get it. We are in the same boat now. I'm waiting on my appeal but it can take as long as 60 days, and I guess they will use all of it and in the end will be a big NO!!! I'm sure you will get it, keep ups posted.My fingers are crossed for you.

How are you? Did you have your surgery?

Thank you my friend. How is your journey? Did you get approved yet?

I submited my appeal today. Pray for me people!!!!:thumbup:

I submited my appeal today. Pray for me!!!!!!!:thumbup:

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.

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.

I'm glad for you. I noticed your BMI is under 40. Do you have comorbs? I was denied at 38BMI and I will resubmit since I pu on 20lb and now I'm on 40.8 BMI

Do an appeal and write a letter sometimes I think they just want us to appeal.

The same happened to me and what they gave me was the guide lines (100lb over and one comorb or 200% over weight) and nothing else. I am now over 100lb and I'm trying to get my PCM to prescrive me diabetes meds, but I'm not sure will work. Maybe you need to add some ponds, maybe will work. Get the 200% of your weight adn then you will not needa comorb.

Start your appeal process and do whatever it takes to get it. I packed some "extra weight" hopefully will work this time. I hope I can resubmit next week. Don't give up.

DO I need to tell you how HAPPY I am for you????? CONGRASTS!!!!!!You deserve it.

Well here it is: I gained 30lb (did not reach the 100lb over by THEIR scale table), I also ate chocolate before my fasting blood test so my blod suar went up 103 and I shrunk 2 inches. I still got denied because of the 100lb. I guess I need to get some ankle weights???? Good luck.

Got my letter from Tricare. Did not answer any of my questions. This is what it says: Based on the review of the request for authorization, our physitian reviewers have denied the request. Tricare will not pay for these services because they are not covered according to the TRICARE Policy Manual. This is a factual determination based on the indication below. Using the current Metropolitan Life Tables <LI class=li_a>The patient is 100 pounds over the ideal weight for height and bone structure and has one of the following associated medical conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints. The patient is 200 percent or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category. I really wonder if they considered me as a diabetic or not. I do now I am 228lb and 5'5 and medium frame so I guess I need at least 10Lb to 15Lb. I'm already looking for ankle weights and waist weights so I can weight in. Any sugestions?????

What it is getting me more mad is the fact I DON"T KNOW WHY I WAS DENIED. They told me I was denied by the Medical DIrector an dI need to wait for my letter on the mail (7 to 10 bus days). I had a very bad day it was like the world had fallen on me. My husband was great and weants me to forget this hole thing and try to change my life habits and start exercise. I wish I could pay for the surgery.... Maggie good luck on your appt tomorrow. Let us know how it was.

I was denied today and I don't know he reason yet. I can't believe it.

Hi, just checked online and it was showing a code: ANC and I called and I was told I was denied and since the letter was not generated I have no idea WHY I was denied. I guess I will see if I can appeal or not.

Are you serious???? Today was a real Soap Opera. You have no idea. I called Tricare, they told me they never got anything. I called Yvette(surgeon coord) and she garantee she had send it. After calling Tricare a few times and trying to contact Yvette again, I left her a message asking her to fax it again and I also told her I could go there and fax it for her, if she needed. She never called me back. At the time my husband got home I was in tears with all this run arround. At the same time Yvette called me telling me she had refaxed Tricare and now she had a confirmation and she had faxed to other fax number. I will call again tomorrow and see whats going on. ONE MORE DAY TO WAIT. Thanks for the support, Maggie.

I will try. When I called the Surgery Coord told me she had send to Tricare everything they needed and when I called Tricare they told me they still needed more clinic info and that the Dr's office had requested a call. I gues this will take way longer then I was expecting. Thanks for all the support.

Why is she telling you you are not gettin approved? Are you way under weight??? They should not tell you that.

Hi, I called Tricare and they told me the surgery coodenator had called tricare and she asked to talk to the nurce in charge, but at least she called. Maybe by monday I will know something. I guess will be a LONG weekend.

Ashley, you will need to work the "system" a little. I went to my PCM and cryed and told her how miserable I was and how much I needed the surgery. I'm not 100lb over but before my blood work, I had some chocollate and my blood sugar went up, after that, I put on a little more pounds and after getting the approval for the surgeon, my PCM also helped me to get a sleep study. I had my PSY eval (tricare will give you 9 seccions with a PSY, just don't tell Tricare is for WLS eval, just do it as a consultation, you will have to let the PSY Dr. know, of course you need a eval for WLS. I also "got shorter" 2" hehehehe, making my BMI higher. I'm not sure if it will work, but since they never want to pay for anything, I think we need to do our part sometimes. Hope this help you and DO NOT GIVE UP.

I called at the end of today and still nothing. I had decided to be there tomorrow at 9am but my husband thinks I will getting her pissed off at me and this will not help me at all. He told me to wait, like it is easy

I'm having the same problem now. I have ALL my stuff ready and it was faxed on friday to Tricare (It could be done on thursday but the surgeon coord did not fax it), on monday I called and they told me they needed some referral form filled out. Yesterday, I called again because was still pending and I was told they need some "clinical info" from the Dr's office, I keep calling the surgeon coord and when I finnaly got hold of her yesterday she telled me she was too busy and had no time to talk to the Tricare nurse. I called today all day and she still have not send the info to Tricare. Apparently the nurse at Tricare wants to know if I am taking medication ofr Diabetes and other info and I'm depending on this lady. Wait is killing me.

I know, I think you were approved by what they told you. I'm also a control freak and I think I am getting everyone insane at Tricare and also at the Dr's office. Can you imagine my family? I just want an anwer and NEED to be the A letter. Let me know as soon as they approve you. I think my surgery in case I get approved will not be until end September because my Dr. is very busy. As long as I get this before October, I'm happy. GOOD LUCK.