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Appeal with TriWest.

SinCityGal

By SinCityGal, in LAP-BAND Surgery Forums

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SinCityGal    43

SinCityGal
Posted

Hi everyone,

Has anyone had to do this & if so, was it successful?

Any advice right now would help so much.

Thank you,

SCG

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lassie    247

lassie
Posted

I have Tri-Care and had to do three appeals. It was worth it in the end and hey what do you have to lose. No pun intended hugs :)

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kazjim98    618

kazjim98
Posted

Wish I could help :( I'm rooting for you SCG...

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lassie    247

lassie
Posted

Thanks guys!

Lassie, 3 appeals, really? That is very frightening! :o

The first one they turned down because my sleep apnea was not bad enough to qualify.

The second time my doc put in for my weight (which was borderline for their requirements).

They turned that down because I needed to be on a documented six month nutritional diet.

After my six month they turned me down because I had lost just enough weight to be under their guidelines. I was about five pounds under.

So I went back to the nutritionist for another month and gained back the five pounds and two more.

My doctor resubmitted to paperwork one more time and they approved it.

It has been a journey but so worth it, Hugs

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SinCityGal    43

SinCityGal
Posted

Lassie,

Were these actual appeals where you had to write a letter? Or just resubmitting the paperwork? Also how long did each one take to get a response? Did the doctor help you at all with the process?

Sorry for all the questions, you've been a great help!

-SCG

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lassie    247

lassie
Posted

Lassie,

Were these actual appeals where you had to write a letter? Or just resubmitting the paperwork? Also how long did each one take to get a response? Did the doctor help you at all with the process?

Sorry for all the questions, you've been a great help!

-SCG

The second time my Doctor office did write a letter not sure if it was an appeal. I think they just kept resubmitting the paper work. My doctor's staff did everything they were the best. Good luck to you and hugs

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lassie    247

lassie
Posted

The second time my Doctor office did write a letter not sure if it was an appeal. I think they just kept resubmitting the paper work. My doctor's staff did everything they were the best. Good luck to you and hugs

I forgot to answer one of your questions. The time-line on each was just about a week.

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