denied by tricare...lost all hop

[SuzanneG 1]

kfgates, I'm happy to share my letters to you and to anyone who needs them! Just PM me your email address and I'll shoot them right out to you!

I figured it would be harder for them to deny me if I had 5 doctors telling them that they thought it would benefit me.

Best of luck!

[rhondalou117 1]

I am still waiting for my insurance desicion, but I did send in pics from my childhood to present day, so I was no longer just a number.

[Judy145 0]

Hi Everyone, I also have TriCare Prime. I have been "fighting" with them for almost a year. I am in the process of writing an appeal letter. I saw a form in a weight loss magazine(don't know which one) that a Dr. had a form that your own personal Dr. could complete to help you get approved. Anyone know where I could get my hands on that letter I sure would appriciate it.

[seriousaboutit 0]

hello all sorry i havent been on in so long things have been crazy! I went for my sleep study but I dont have apnea:frown:. However I did go for an MRI and it showed mild degenerative changes in my lower back as well as slight arthritis....im not sure if this is gonna be good enough for tricare but im not giving up my band drs assistant is sending me all the paper work that they have cause aparently I have to file the appeal...whatever thats fine with me I would rather have it in my hands I hate having to depend on others! anyway if anyone has any advice I would appreciate it!:smile2:

[JamieNP 20]

I reweighed, and had gained 12 lbs, meeting the requirement for Tricare ( I needed 6.5 lbs). My surgeon's office is resubmitting everything. Hopefully they will approve, since their letter stated that was what I needed to weigh.

Wish me luck!

[aculberg 0]

Yay! I'm sure you'll get approved now. Best of luck, keep us updated.:thumbdown:

[thatDEgirl 1]

Tricare is usually VERY easy to get approved by IF you meet the requirements.

TRICARE only covers morbid obesity surgery such as gastric bypass, gastric stapling, adjustable gastric banding and gastroplasty when the beneficiary meets one of the following conditions:

• Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints
  
• Is 200 percent or more over ideal weight for height and bone structure
  
• Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery
  

As for the conditions, they must not only be noted but my surgeon told me you also had to be treated for them. Not 100% sure on that part.

[JamieNP 20]

Oh, I have been on blood pressure medicine for 12 years and CPAP for a year. Tricare said that I meet the requirement there..just needed 6.5 lbs. (AKA a couple of sonic cheeseburgers, mozzarella stix and a heavy sweater).