Sooooo PO'ed at Tricare!!!!

[sockmonkey 0]

I was denied, appealed the denial, and my appeal was denied. All because of so very little. I met the criteria for 100 lb. overweight, but my comorbidity was "not severe enough". (sleep study showed sleep apnea requiring CPAP therapy but too low of a severity index for bariatric treatment. And I was 6 lb. under for 200% over ideal weight.

My weight loss center was shocked. They said they've never seen such stringent policies. And I'm left fat. My surgery (which was supposed to be Friday) was cancelled. I'm trying so hard not to cry right now. :confused:

[SoccerMomma73 1,867]

I would cry, a lot and then I'd stress eat and gain about 10 pounds. Now, I'm NOT telling you to gain weight to get approval. But I would have been so upset I would have gained a good 10 pounds. Don't give up!!!

[sockmonkey 0]

I already worked my tooshie off to gain 10 lbs so that I would qualify with 1 cormorbidity!!!! 10 more lbs now seems completely disgusting. I'm so frustrated!!!

[sockmonkey 0]

Update:

Since the info I was given regarding my denied appeal was relayed through the replacement staff (my person was on vacay), I called her back the following week. She had heard NOTHING of the appeal or denial. After doing an hour of research she discovered that Tricare DID NOT deny my appeal, but one of the doctors there gave the weight loss center's staff attitude about my sleep apnea severity and said not to expect it to be approved. I waited one more week and on Friday, I got a call from a woman at Tricare telling me that I was approved. :biggrin:

I know 2 other women locally who have been denied initially by Tricare but then won their appeals. Makes you wonder what the thought process is over at Tricare. Perhaps they are denying everyone initially.

In any event, I'm getting a Lap-Band!!!!!

[Cocoabean 430]

Oh wow, that was a pooper to go through! Congrats!!

I don't have tricare but my request for consult was denied. My PCP said almost all initial requests (through that medical group) are denied in hopes you will go away. He has since changed groups.

I appealed and won.

Looking forward to your losses!

[sockmonkey 0]

Thanks so much for the well-wishes, Cocoabean!