Denied by tricare ....................i guess it wasnt meant to be

[babygirlsmom29 0]

hey I was denied by tricare....I have no clue of what to do next aww well I tried guess I need to find another solution...Thanks for all the prayers and support.

[Rsilversea 2]

Contact your surgeon first. They will try an appeal but you need to do one also. I think the reason my appeal was denied was that the letter I sent was not complete (I had typed over a "form letter" and forgot to finish it). Don't give up just yet. I'm going to try one more appeal (and double check my letter this time!)

[delta27 0]

Don't give up. I was denied my first time. I appealed and turned in all supplemental information I had and was approved. I will be here to help you. If you need help with writing your appeal letter let me know. What is your Tricare Region.

[babygirlsmom29 0]

Thanks very much I am in the North region....can you send me a copy of your appeal, I have no idea of what to write or where to begin well I found out this evening so I will contact my surgeon office on Monday. I need help and dont know what to do........my email address bajanbk69@hotmail.com

[Rsilversea 2]

I was just told my appeal was approved. I find this interesting since the letter I sent in still had parts of the form letter in it (forgot to finish the letter, oops). More than likely, you will get approved. Just don't lose heart and stay strong.

[babygirlsmom29 0]

Can you send me a copy of your appeal my email address @ bajanbk69@hotmail.com. My surgeon office is working on my appeal right now, but I need to write my letter also. Please send me any info that you think I might need. Thanks for the support....Congrats on your approval.

[babygirlsmom29 0]

So today I went to see my PCP and was diagnosed with hypertension and was given med so I faxed that information to the surgeons office and she should be sending it over to tricare as additional information. I am hoping and praying that this works out for me......

[Rsilversea 2]

Bet you hear something positive in a week.

[babygirlsmom29 0]

Did you submit your appeal on line or fax? Just wanting to know so I can have mine done if needed.

[Rsilversea 2]

My appeal was done via fax.

[babygirlsmom29 0]

Finally I got my approval in less than 24 hours after faxing my additional information and send my appeal yesterday evening....thanks for all the prayers and support.

[BabyGirl2730 3]

I don't mean to butt in on your conversation but my husband is military and we are stationed in WA. I am actually at the end of my pathway and getting ready to see the surgeon next week to set my surgery date. The steps I took were very easy and should be for you, if you are near a military base that provides the surgery. I never once had to write any letters to tricare or anyone. All I did was go to my primary care doctor on post and she put in what they said was a referral. You go to this huge meeting at the hospital with a group of other people (which you need to get there early because the whole process is first come first serve) and listen to the surgeon and plastic surgeon give a conference on the different types of surgery and what all everything intels. When you show up and sign in your name automatically will be put on a list. The waiting time for me to start my pathway was about 3 months. You will go through mandatory classes which I completed in 2 weeks then you will see a shrink and do a personality test that can take up to 4 hours. you go back in a few days to a week to get the results and then from there you will make you appt with the surgeon and at that initial appt you will schedule you surgery date which is usually out about a month. As long as you have a BMI of 40 or 100 pounds over weight OR you have a BMI of at least 36 and health issues such as high blood pressure you should have no problems. I have a BMI of 38 and I have blood pressure and had no problems what so ever through the whole process, I never once had to even deal with tricare. I'm not sure what steps you have taken but if you go to you doctor and have them put in the referral you should have no issues. I hope that I've been able to help :tongue2:

[babygirlsmom29 0]

Thanks very much for the info but the reason why I was referred to an outside surgeon was becasue the surgeons office on post was not accepting anymore patients and the wait list was 2 years. I got my approval for surgery from Tricare last friday after additional info was sent to them for review and I am schedule to have surgery on 2 June....Good luck and i hope all goes

[Perk25 0]

I don't mean to butt in on your conversation but my husband is military and we are stationed in WA. I am actually at the end of my pathway and getting ready to see the surgeon next week to set my surgery date. The steps I took were very easy and should be for you, if you are near a military base that provides the surgery. I never once had to write any letters to tricare or anyone. All I did was go to my primary care doctor on post and she put in what they said was a referral. You go to this huge meeting at the hospital with a group of other people (which you need to get there early because the whole process is first come first serve) and listen to the surgeon and plastic surgeon give a conference on the different types of surgery and what all everything intels. When you show up and sign in your name automatically will be put on a list. The waiting time for me to start my pathway was about 3 months. You will go through mandatory classes which I completed in 2 weeks then you will see a shrink and do a personality test that can take up to 4 hours. you go back in a few days to a week to get the results and then from there you will make you appt with the surgeon and at that initial appt you will schedule you surgery date which is usually out about a month. As long as you have a BMI of 40 or 100 pounds over weight OR you have a BMI of at least 36 and health issues such as high blood pressure you should have no problems. I have a BMI of 38 and I have blood pressure and had no problems what so ever through the whole process, I never once had to even deal with tricare. I'm not sure what steps you have taken but if you go to you doctor and have them put in the referral you should have no issues. I hope that I've been able to help

I'm so glad you posted that!! I'm going to try and get a refferal wednesday from my pcm and I am the same weight height and bmi as you , I don't have high blood pressure but I have had back problems for like 6 years and taking anti depressants for 5 years so hopefully that will help. You gave me some hope anyway:) Good luck and congrats!

[kellyjoiii 19]

I don't have high blood pressure but I have had back problems for like 6 years and taking anti depressants for 5 years so hopefully that will help.

Tricare has specific co morbidities they look for (if you do not have a BMI of over 40. If it is over 40 (typically) they will approve you. They typically only do it with a BMI under 40 with High blood pressure, diabetes, or DIAGNOSED sleep apnea. This is what I have heard anyways. I have a girlfriend who has a bmi of 40 with no other problems and just had the surgery done three weeks ago. I myself had a bmi of 39 but had HBP to go with it. I got the referral and then went to a dr (non-network at that) and had the surgery 60 days after my start. That was April 29th. They paid for both of our surgeries. Good luck to you and dont let them push you behind. Stick with it...appeal and I am keeping my fingers crossed for you!