Help, insurance problem :(

[thaskett 1]

Hello, I am new to the forum and needing advice. I have tricare standard north region. BMI is 45 and I have hypertension. My surgeons office indicated that I needed to go through a 6 month doctor supervised diet to get approval which was fine but tricare has denied to pay for these visits. They cost $165 each month and I cannot afford to pay this out of pocket. My question is this- why can't my surgeons office just submit my paperwork for approval without these 6 months of doctor visits? I have all of the other tests completed for approval. Are these doctor visits for the surgeons or is it a real requirement for tricare standard? I am wanting to call my surgeons office and tell them to go ahead and submit what I have now. Any suggestions or thoughts? Has anyone else had this issue? Please advise Tracy

[SoccerMomma73 1,867]

Call your insurance company and ask for a written copy of their criteria.....a LOT of insurance companies are changing from 6 months of supervised weight loss to a couple years of documented obesity (you get weighed every time you go to the doctors office so it'll be documented). Some will even take documented proof I'd weight watchers and such. Good luck! Don't give up!!!! Also $165 a visit with no labs, etc is a bit much!!!

[Butterfly66 63]

Did Tricare tell you why your visits would not be covered? That doesn't sound right.

My insurance required six consecutive months of doctor visits to discuss diet, exercise, Portion Control, etc. and document my weight, but they were covered with just a co-pay required per visit.

I know Tricare also requires the six month visits as my kids are covered under Tricare.

My suggestion is to make a doctor appointment every month for something separate, but weight related (tired, sluggish, stomach problems, trouble sleeping, etc.) and discuss diet and exercise while you are there. That way you will only have to pay the co-pay.

Just a thought.

[ArmyWife&Mom 24]

I have tricare prime remote and was not required to do any diet. I was required by the nurse advocate to call insurance and fill out a questionnaire on the requirements. who I spoke to. Date and time. My BMI is 35.2 sleep apnea. High cholesterol. Hernited discs. S1 fracture.arthritis. fibromyalgia. Gerd. Hernia etc. I am only 45 and feel like I sm 75!! Call directly and look online at the coverage.