External appeal Tricare?

[Schoe394 7]

Hello I had my surgery done two years ago and meet the requirements through a army hospital. At time of surgery I loss weight and was down to a BMI of 33.8 and I had two co morbidities. Fast forward to today and I need a revision because my sleeved failed( doctors error). Tricare denied me and my appeal because I don't meet the civilian standards from my original surgery. I meet them now though but because at the time of surgery I was under BMI. I am going to do an external appeal because I need a revision. Any help on what I can do or add to my appeal would be great. Also if you had an external appeal with Tricare could you let me know how the process was! Thanks

[ShelterDog64 2,364]

@@Schoe394 I don't think you can do an external appeal with Tricare. You're in WA, correct? Did you have your surgery at Madigan? If so, have you gone through all the hoops at the facility to try to get them to help you with Tricare? If you're Standard vs Prime, you may have no other options.

Also, you said your sleeve failed due to surgical error...do you have this documented by another surgeon? You may be able to go back to that surgeon and have her/him help you with the appeal.

[Schoe394 7]

Tricare said I can do an external appeal and are sending me the paperwork to do it. I was in Washington when I got the original surgery done and now in Illinois. My new surgeon has written a letter saying that it was a error and that I will need to have a revision but I still got denied.