katwmn63

i am so confused and frustrated!! i have been waiting for my tricare approval, since the 12th. everyone else on this sight can go online and check there status (approved/disapproved)...i can't until i get a security code in the mail after my registration. i am in florida trying my best to enjoy a vacation, so the security code is likely sitting in my mailbox back home in illinois. so instead i call tricare...everyday. the first day was a false "approved", yesterday was "still peding under medical review" today i kind of got the same thing but was put through to a medical manager. here is what she said. "this is a limited benefit..you must meet certain criteria for tricare to pay" kk thanks, i knew that.. " then, "you don't require preauthorization-when is your surgery scheduled?" i told her we were waiting for tricare approval...she said, "oh, well this doesn't require preauthorization, as long as your doc sends in all the clinical info showing you qualify..." i said, why does everyone else get an approved or disapproved?...she said "well your doc will get something faxed in 7 days or so, but no preauthorization is required for this benefit. why does all other Tricare folks that i have read about here get an answer in an average of 2 days that says simply "approved or disapporoved" ? I am very confused...very, very confused!!:wink2:

wonderful!!! i wish mine went that fast, but it's looking good. mine was submited 5 (bus) days ago. tricare called me and the surgeon this morning and stated that all they needed was my esophagram and thyroid results.....they were both faxed this afternoon. so far so good. good luck!

you go jason!.. i am waiting for approval from my insurance co, and have decided that even if they don't aprove me, i will do a 2 week liquid protien diet and ease into atkins after that as a way to once again punch away at my weight loss....with or without the band. i'm with you either way! you can do it! -kat

sharmom- did you have the surgery before you submitted your claim for reimbursement through tricare standard? i too am tricare standard...every time i call them to ask if i am pre approved...they tell me i don't need preauthorization for the surgery.. i looked on line though andit just states i am in process" any thoughts?

congrats to you! you're on your way!!!!!

good luck! my paperwork was submitted to tricare on the 12th.. i am still waiting (after a false alarm for being approved monday). are you tricae prime or standard? keep us posted!!!

yes... i am going to Dr. Vafi Shayani out of Saint Anthony's in Rockford ( he has 2 other locations as well). His clinic is wonderful and his staff is top notch! His assistant, Kim, really know the in and outs of the insurance requirements, and she is on the ball with returning calls and emails. His center also has the accreditation of Center of Excellence. Bariatric Surgeon Profile - Vafa Shayani, M.D., F.A.C.S.

so i called my insurance company (tricare) this morning...i just couldn't wait. he stated he had the referral from my surgeon, "we have it as pending...but...oh...just a second hold on... it was just sent up for approval..." i said what does this mean? he said " they don't do that unless it is aproved" i'm so afraid to hang my hat on this... but for now i'll take it!

i'm with ya!! waiting on my insurance company's answer myself. good luck!!

this is reall tough. paperwork went in last friday to Tricare with the folowing stats: 5'3" 230, BMI 41, sleep apnea, arthritis, depression. i am in florida for vacation and a family reunion. i wonder if this will end up being a place for celebration ..or be completely ruined. for now i am just trying to enjoy my family, but i can't help but worry....

Thank you all for the positive thoughts!! ps. i'll take ur advice Jennifer and call tricare on wednesday! i'll update then:)

Does anyone know, when an insurance company requires you to be 100 lbs over ideal weigt according to MetLife chart, do they mean the lower or higher weight in that given range for medium build? For example: MetLife ideal weight = 119-132, do you qualify as 100 lbs over ideal weight if you are 219? or 232? hmmmm thanks

if anything, i would think that you are living breathing proof that the band works for you!!! surely your records will show that, and that you were a much "healthier" weight with it than without it. i would think your chances are even better now if you have the same stats as when you qualified before. i do hope this turns out to be the case! best of luck!!

hope2bthinr Thank you!! That excerpt helped:)

i couldn't stand it any longer so i called tricare. the above note is correct about contractors addingthe 100 pounds to the lower and higher...it is so to qualify for morbidly obese one would have to fall within the new range: for example: 5' 3" med build ideal= 121-135 for 100 pounds over, one would need to be the new range of 221-235. for 200% it would be 242-270. whew... i never thought i'd be happy to be considered morbidly obese:{

WOOOOOO HOOOOO WTG Jennifer!!!!!!!!!!!! let us know when you get a date:)

Congrats to you!!!! WTG!! keep us posted on your success:)

believe me jennifer, i am stressing right along with you! we'll get it!!! ps. i just found out mine wasn't sent yet... I gave my psych the wrong number to fax the dictation to. resending today:[

I am looking for info on denials from Tricare, both full denials, and denials that were reversed after appeal. I am wondering what reasons they have given for denial of the benefit, and, what denials were reversed and how. If you don't mind sharing this information I would appreciate it. I am someone waiting for approval with Tricare and anticipating the worsed as you can imagine. But a denial won't hold me down, and avanced info on what to expect and how to appeal would be helpful. I am the type to have a contingency plan in place. Thanks!

well... if that is the case i am 4 pounds short. if it were the lower end of that range I would be 107 poinds over ideal weight. should i expect to be disqualified for this i wonder?

that is my initial assumption, but when it comes to insurance companies..... thanks

try posting your question in the "post op" rather than "intro" or "preop" section of the forum. good luck

i think this question would best be answered by those in the "postop" rather than "preop" forum... see if any there have had this symptom. I do know that my step-mom had good results taking prenatal Vitamins for hair loss...though her hairloss was not related to a diet. there could be Vitamin deficiency during dieting that causes the hairloss... a supplement would fix it in this case... just need to identify the vitamin?? good luck!!

just to clear things up... it is NOT required that you have had a surgery for wieght loss before....that is only one of the possible ways you can qualify with Tricare. if your ideal weight is 115 and you weaigh 230 (or more).. then you are at 200% of your ideal weight -this is another way you qualify. otherwise, if you are 100 lbs over your ideal weight (or more) and also have a comorbidity - (a medical condition related to being overweight), then you also qualify. i hope this helps... don't be discouraged...you're there:)

you'll be surprised the questions that will come to mind once he starts explaining/reviewing things. just be sure to ask him what to expect, and what is the most important things you need to do to be successfull. That will surely open up plenty of discussion. Good luck!