denied by tricare...lost all hop

[seriousaboutit 0]

:crying:I just found out that I have been denied by tricare i meet the hundred pounds over weight requirment however I dont have any co mobilities or whatever the heck they are. Although I am 10% disabled from the army for my back, but they never found anything when they did mri's or x rays. Maybe its artritis maybe not but unless it is I cant get the band. My band dr is now sending me for a sleep study maybe that will turn up something but the way my luck goes it will probably come back normal. I am so upset apparently being fat as heck doesnt validate surgey.I have to have diabeties or heart problems, i wonder if they remember that being fat causes diabeties and heart problems! If anyone has any advice I would greatly appreciate it, sorry my posting is so misserable its just the way i feel. :crying::Banane03::crying::Banane11::crying::Banane06::crying::Banane02::crying::Banane22::crying::Banane08::crying:

[SuzanneG 1]

APPEAL. BC/BS denied me the first time through too. Get a letter of support from any doctor that treats you for anything that would improve with weight loss, pediatrist, GP, Gastrointerologist, etc.

If you need sample letters, I'd be happy to share mine, just PM me.

[iwalktheline 1]

If your BMI is over 40 it is just a matter of time before you get approved. APPEAL and get your Doc to write a letter about how it is life or death. GOOD LUCK

[secretstolen 4]

I'm reiterating what has been said by others: APPEAL. Exhaust every option to appeal their denial.

I'll keep my fingers crossed for you! Good luck!

[Snapdragon 0]

:crying:I just found out that I have been denied by tricare i meet the hundred pounds over weight requirment however I dont have any co mobilities or whatever the heck they are. Although I am 10% disabled from the army for my back, but they never found anything when they did mri's or x rays. Maybe its artritis maybe not but unless it is I cant get the band. My band dr is now sending me for a sleep study maybe that will turn up something but the way my luck goes it will probably come back normal. I am so upset apparently being fat as heck doesnt validate surgey.I have to have diabeties or heart problems, i wonder if they remember that being fat causes diabeties and heart problems! If anyone has any advice I would greatly appreciate it, sorry my posting is so misserable its just the way i feel. :crying::Banane03::crying::Banane11::crying::Banane06::crying::Banane02::crying::Banane22::crying::Banane08::crying:

Please don't give up hope. This is just an obstacle. First of all, let's count your blessings. Having two co-morbidities myself, please rejoice in the fact that you don't have any. Oh what I wouldn't give to not have to take high blood pressure medications. I've been taking them now for 15 years! I was diagnosed with Type II diabetes last June and since I've been banded I'm off my meds, but I'll always have diabetes.

You probably don't want to hear this, but maybe the LapBand isn't what's meant for you. Stand back and ask yourself, "Why is this happening and why is it happening now?" Probably one of the best things I ever heard my pastor preach on.

Use this time effectively. If you haven't already started, continue with your weightloss. Keep exercising, keep eating right. Work with your doctor, do as he says and let him be your advocate.

Consider writing a letter to your insurance company appealing their decision. Write how your weight challenges you in your daily life, send photos of yourself....tell them your hopes for the future and being obese prohibits you from a future.

Sometimes insurance companies just say "no" right off the bat. I've heard of many times people going back and challenging a decision and they get approved. Don't lose hope!

[CaliGirl626 0]

What the insurance company wants you to do is to be upset, lose the hope, and just give up. DON'T DO THAT!!!

Fight for it. Talk to your doctors, to the ins company, you are just a policy number. Your doctor knows you and knows about your health.

I couldn't get my insurance to approve my surgery also. My BMI was borderline. however, i had High blood pressure and Diabetes.

My hubby and I ended up biting the bullet by paying for the surgery on our own. It is an investment on my life. I have the band for 2 months now and I just couldn't be happier.

Good luck to ya!!

[Jeanmarie 0]

Dont lose hope! I went for my initial consultation on 8/7/07 and FINALLY got approved 2 weeks ago and my surgery is 7/29/08. Took a whole year! Go get the sleep study, the results helped me get approved. Good Luck!!!

[AZArmyWife36 0]

APPEAL. BC/BS denied me the first time through too. Get a letter of support from any doctor that treats you for anything that would improve with weight loss, pediatrist, GP, Gastrointerologist, etc.

If you need sample letters, I'd be happy to share mine, just PM me.

Hi! I was denied by Tricare as well. I'm not sure on what I really need to do for the appeal. Did you write a letter yourself or did your PCM provide you with one? I'm not 100 overweight but I do have asthma, PCOS and high blood pressure. Though I'm not being treated for the high blood pressure. Any information is greatly appreciated! Thanks so much! Brenda

[seriousaboutit 0]

Thanks so much for all the support. Im not going to give uphope I was just really bummed well I still am, but I called and made a apt with my dr for monday to talk about getting an MRI. I also have an apt to have a sleep study done. Im notsure if tricare will approve me with sleep apnea or if I have to have narcolepsy. If anyone knows I would love an answer. SuzanneG I would love any examples you are willing to share! I will take any help I can get! Thanks again to everyone! I will keep you updated on my progress.

[SuzanneG 1]

I wrote 2 letters myself, one about the medical need and another about the emotional need. Then I asked every doctor who treats me for anything weight related to write me a letter of support. i.e. Gastrointerologist - GERD, GYN - incontenance (almost always weight related and mine went away quickly after), Podiatrist - ankles, feet, arthritis, GP - High BP and Chol. You get the picture. I then went back to the bariatric surgeon and had him write his own endorsement and they sent the entire package in. BC/BS called me directly and said she had never read such a letter and approved me and wanted to tell me directly.

I'll share with anyone who wants it, just give me your email address and I'll send them your way!

Good luck!

[JamieNP 20]

Ok, I went to my surgeon today and they said that Tricare pays for almost everyone. She said she was sure they would cover mine. Make sure you have everything into Tricare that they need and anything that will support your need for surgery. Get a sleep study done...chances are you have some degree of sleep apnea. I am soooo excited!! I will be an "August...what ever we are calling ourselves"!:crying:

[kfgates 0]

Suzanne, I was reading thru this thread...I am trying to get my ducks in a row and noticed you were willing to share your letters. I have a low BMI but do have co-mobitieies ie: herniated discs, stress incontinence, plantar faciatis (fallen arches) and Gerd. I like the idea of getting letters from other docs...ie obgyn etc...would you be willing to share your letters with me?? Thank you in advance for any help you can offer. Kimberly

[AZArmyWife36 0]

I wrote 2 letters myself, one about the medical need and another about the emotional need. Then I asked every doctor who treats me for anything weight related to write me a letter of support. i.e. Gastrointerologist - GERD, GYN - incontenance (almost always weight related and mine went away quickly after), Podiatrist - ankles, feet, arthritis, GP - High BP and Chol. You get the picture. I then went back to the bariatric surgeon and had him write his own endorsement and they sent the entire package in. BC/BS called me directly and said she had never read such a letter and approved me and wanted to tell me directly.

I'll share with anyone who wants it, just give me your email address and I'll send them your way!

Good luck!

Thanks so much! My email is cafe15@yahoo.com! Have a GREAT Monday!

[aculberg 0]

Those of you that have been denied - did they say why? Maybe its just something easy like lack of paperwork? (thinking positive!) I am soo terrified of that happening to me, after all the tests and hoops I've had to go through....I would definately appeal it, it will take longer, but then you'll get their attention and say "hey look at me" Good luck!!

[JamieNP 20]

Let me share something I have in my booklet from the surgeon. It is from the Obesity Action Coalition. Find out exactly why they denied you. It may be as simple as a wrong code or something missing from the file. This should be a detailed reason why. Do this asap because there are some time restraints on filing an appeal.

In your appeal letter, write down any and all weight loss programs you have tried. This includes Richard simmons tapes/books, any gyms, the cabbage Soup diet, any diet pills, slim fast, etc etc. If you are like me, I could fill a whole page of diets that I have tried over the year. I still have my Cher and Cindy Crawford...heck I still have Jane Fonda's Work out tape!!

AND...most of all....they say "don't get discouraged". Most people will eventually get the decision reversed.

Good luck!!