hope2bthinr

I hope this worked!! Hi Y'all!! We're finally here, doing it!!! YAY us!!! Good luck everyone!

Ok, just because I'm curious and in awe...please tell us what your 1 yr anniversary weigh-in results are??? (wild clapping in the background....drumroll.............) and HAPPY BANDIVERSARY!!!

Ok, just a surgery date (19th Oct)....but I'm thrilled!!! I can't believe it's actually going to happen!! I go to my preop appt today. OMG, OMG, OMG!!! My closest friends and hubby are the only people I've told, and they are so supportive and excited for me. I'm so lucky to have those friends and my loving husband. Not really related but the weather has finally shifted here and if it stays this nice we are going to have a great fall/winter/spring (all three kind of blend) and the lower temps will make it much easier to recover and get active again, quickly. I'd sure like to see some changing leaves on something other than a cactus! Will have to take some weekend jaunts to find the trees changing.

Ok, just a surgery date (19th Oct)....but I'm thrilled!!! I can't believe it's actually going to happen!! I go to my preop appt today. OMG, OMG, OMG!!! My closest friends and hubby are the only people I've told, and they are so supportive and excited for me. I'm so lucky to have those friends and my loving husband. Not really related but the weather has finally shifted here and if it stays this nice we are going to have a great fall/winter/spring (all three kind of blend) and the lower temps will make it much easier to recover and get active again, quickly. I'd sure like to see some changing leaves on something other than a cactus! Will have to take some weekend jaunts to find the trees changing.

I'm the 19th!! Woot!! Woot!!

I was approved after being denied the first try. I wrote an appeal letter giving additional details on how my weight affects my life and limits my activities. I double checked the information sent in by my Dr, and made sure info was included from my chiropractor saying how many times I had seen them for back pain (I don't take a lot of pain meds since I prefer to try to fix the problem instead of only dealing with the symptoms). In the letter, if you write one, make sure you state your stats, ht, wt, bone structure, and include the metlife ht wt chart for ideal wt with your ideal wt circled. I even calculated 200% of the high end and put it on the paper. Make sure it sounds like you have been well informed as to what the requirements are, what the procedure is all about, what the risks are, etc. My appeal took about 10 days to finally get approved for authorization. With your stats I can't help thinking that either there's a mistake or your age is keeping you from qualifying. Tricare seems to be pretty rigid on their guidelines. I almost forgot, read your denial letter and find out what it is they are denying you for and that should point you at what has to be addressed/corrected, etc. Details, details, details!!! Keep trying and don't give up!!! Good luck!!

My "Band Birthday" is October 19th. WOOHOO!!! I am so excited!!! After trying to get here for 6 months, I'm really, really, really ready....LIKE YESTERDAY. I've been reading the good, the bad and the ugly for that long and still think it is worth it, so here I go!! Here's wishing everyone here will be "big fat losers"!!! (in a good way of course )

I checked the website today on a whim and found that my authorization is finally approved!!! I'm SO EXCITED!!!:thumbup::thumbup::hurray::crying::hurray::thumbup:

I checked the website today on a whim and found that my authorization is finally approved!!! I'm SO EXCITED!!!:thumbup::hurray::cursing::hurray::thumbup:

OMG!!! I AM FINALLY APPROVED!!! I am so excited!! I can't even believe it!! It's been five months from my consult with the surgeon.

I don't understand Tricare at all, and I now meet any definition they can come up with for the 200% of ideal body weight. I have had Tricare available and never used it for the last twenty years because I just used my other insurance and now that I ask for one benefit to be paid....I'm just so darn frustrated with this whole process!!! BUT I AM NOT GIVING UP!!!

Thank you. I finally got someone on the phone today that explained to me what's going on, whether I'm missing anything, whether the Dr. did what they were supposed to, etc. I'm so glad I tried calling one more time. 30 days isn't so bad when this could be something that lasts the rest of my life. I'm just going to be patient and whichever way it goes, it's meant to be. If I get an authorization in that thirty days, maybe I needed that extra thirty days. I think I had myself convinced that after reading so much about the process that I knew how to make it go smoothly. I really don't know how to work through this tricare red tape and paperwork, but I have learned more about it. It's just been a rollercoaster, and if I had understood it all from the beginning maybe I could have avoided some of the delays. Live and learn. I'm sure there's a lesson I needed to learn from all of this.

I don't understand Tricare at all, and I now meet any definition they can come up with for the 200% of ideal body weight. I have had Tricare available and never used it for the last twenty years because I just used my other insurance and now that I ask for one benefit to be paid....I'm just so darn frustrated with this whole process!!! BUT I AM NOT GIVING UP!!!

I'm still waiting after re-eval and resubmit to tricare. FINGERS CROSSED!!!

Lucky me, my surgeon's office called and asked if I wanted to come re-weigh in since it's been almost three months since the official weigh in, and if I meet or exceed the required lbs they will resubmit. BINGO!! They're resubmitting!!! It's a darn good thing I didn't start dieting before finding out if the authorization was granted. I needed every pound and then some!! Must update the ticker!! Still haven't figured out how to make it appear with the link to the ticker factory site intact... oh well.

That's great to hear!! And so glad for you. I'm Tricare Standard and it seems a liitle different. Hard to know what is going to be covered when all is said and done, IF I get authorization. I'm hoping the resubmit and my letter will make it happen. I've been trying to just get to the point of submitting (nearly 5 months) and then to get turned down the first time was pretty diappointing. If I hadn't read on here how many were turned down and then approved after appealing, I would have given up. But it's been a long haul and I'm not giving up now!! So sitting on pins and needles again....waiting...hope to have an authoriazation in the next day or two. Thanks for the comment!!

Yup, what MILWIF said! That's how it was explained to me. So I went on a "weight control" strategy.... Figure out double the high side of your ideal weight range...that's what you need to be to qualify UNLESS you have High blood pressure or one of the other conditions. If you have one of those conditions THEN you would have to be 100lbs over your high side ideal weight. I don't know why they can't just use BMI like the rest of ins companies!! Anyway, good luck on meeting that weight requirement!! Maybe you can still get there.

Lucky me, my surgeon's office called and asked if I wanted to come re-weigh in since it's been almost three months since the official weigh in, and if I meet or exceed the required lbs they will resubmit. BINGO!! They're resubmitting!!! It's a darn good thing I didn't start dieting before finding out if the authorization was granted. I needed every pound and then some!! Must update the ticker!! Still haven't figured out how to make it appear with the link to the ticker factory site intact... oh well.

babyka16, I was just turned down for the same reason. So this is how they figure 200% of your ideal weight... if my ideal weight range on the Metlife tables is 106-118 those two numbers would be 100% of my ideal on the low and high end. So 200% would be double. The new range is 212-236 (for me I would have to weigh over 236). The high one is the one my weight must exceed. I don't know why they even discuss the low end because they only approve you if you are over the high end!! If they would explain it more clearly, they'd have a lot less paper work from people who don't meet the right number. I went back to my Dr. since it's been 3 months since they weighed me and I now weighed in excess of the amount required so they are resubmitting. I had them add a letter from me personally telling how much my weight affects my life and my family history of diabetes, high blood pressure, heart attacks, heart failure, etc. Even though I don't have them, the evidence is there that as the 8th kid and the only one without those diseases, I will more than likely develop one or more soon. I told how much pain I have when trying to be physically active or just clean house and how depressed I am and embarrassed to go anywhere. I hoping if there is any doubt, that it will help. Hope this info helps you know what to do to be successful!!

I WHOLEHEARTEDLY CONCUR!! It just guarantees my deductible will reset before I can get the surgery. My Dr was going to do the procedure 9/29 or 9/30 which would have been just under the wire. At this point I don't even care about the deductible, I'd gladly start over and pay the whole thing if they would just give an approval. I'm still waiting for the surgeon's office to call and find out what went wrong. :blushing:

Thanks, puts it into perspective, but I meet the 200% of ideal if they looked at it the way it was supposed to be submitted (small frame). Other than that I guess I'm too healthy since I haven't (fortunately) developed all of those obesity related issues (no offense intended, please!). I submitted my family history that shows parents and 7 siblings have heart, obesity, diabetes and high blood pressure, but I guess unless my body actually suffers damage and ends up in that boat, it doesn't matter. I'll be talking to them some more today and will take your suggestion to talk with a supervisor if I don't get it corrected through my surgeon calling. I would say you're lucky to be approved but I know you'd rather not have the health issues you have that qualify you, or the weight problem. I'm just frustrated. I walk every day even though my feet are killing me and I've tried every diet program under the sun and always gain more than I lost, tried boot camp private trainer and lost 2 lbs after a year and a half of training. And I am trying not to get the health issues. I wish you the best of success and hope I can join the losers club soon. Thanks for the response and suggestion.

Yippee for you!! Glad yours went so easy. Calling for info isn't the problem, I've made about ten phone calls to them already...getting consistent answers to questions that make the difference between $2000 out of pocket or $25000 out of pocket, is the problem.

I'm going through this stuff with Tricare too. Tricare told my surgeon's office I didn't need pre-auth because I had other insurance and even gave them a authorization #. Then today I called because the website said NOT APPrOVED, but I think someone made a mistake... I'm 5'1", 226lb and small frame, that makes me 200% of my ideal weight between 106-118. My denial said "did not prove medical necessity with the 100lb over + 1 comorb or 200% of ideal wt", that's according to the girl I talked to so I'm thoroughly confused. I think they did not read "small frame" in my file when they reviewed it and I double checked with my surgeon's office to make sure they stated that. Even my primary said I fit small frame. This is such a run around!! Every person you talk to at Tricare gives a different song and dance. One will tell you approved and the next will tell you something completely opposite. I don't even trust that if I get to approval that they will actually pay. First they said they had to wait for the letter from my primary ins saying whether they'd pay or not, that was a full week when the darn exclusion letter was in the original package of stuff they received. NOW I get to wait some more to either figure out the mistake or file an appeal and wait, and wait, and wait..... any suggestions? I'm on oxygen at night because of sleep apnea, not the obstructive type, have bad asthma and fall asleep during the day at work daily, back pain, foot pain, stress incontinence, and I feel like I'm strangling by my own fat when I sleep!! I can't believe I have to be heavier to qualify! good grief, I'd never make it through this process all over again. THIS IS SO FRUSTRATING! I'm having the surgeon's office call Tricare in the morning to see what exactly they were looking at and considering when they reviewed it for approval. It's just ridiculous how you can call and get a different answer each time. I don't know what to believe.

Just have to rant and rave here for a few...Friday my surgeon's office called Tricare and was told I didn't need pre-auth because I had other primary ins so they are moving ahead as if it's ok :thumbup: and even set a surgery date (they even got a pre-auth #)... but then the Tricare website today says NOT APPROVED (WTH?? ) so when I called to find out why and what was going on, I was told I did not meet the criteria for the surgery being medically necessary. :cool: Either the 100lb over ideal weight + 1 comorbidity or >200% of ideal weight ( I met this one at 5'1" 226 and small frame). And of course I find this out right before 4PM so the doctor's office is closed. So I can't have them call today to find out what went wrong. :thumbdown: Anyway, I'm still trying not to get upset, that there must be a mistake somewhere and hopefully it will get straightened out in the morning. :sad: :scared2: :crying: :ohmy: ....I really want to have happy news in the morning!!