Tricare Approval or Denial??

[p3piplpr 0]

Hey everyone this is my first post - I statrted here cuz i figured tricare would be my biggest battle- all the info I am getting from you guys is very helpful so thanks

[cmedwards 0]

WOO! HOO! I got my approval yesterday 7/14/09!! I have Tricare Prime - South and it only took 2 days!!! Now I'm waiting for the scheduler to give me a surgery date.

My journey has been very smooth thus far. Only because I started on this site a couple of weeks before I started my pre-op requirements and gleaned a lot of useful information from all of you!!. Thank you! Thank you! Thank you!

6/20/09 Seminar

6/22/09 PCM Visit - Letter of Necessity

6/23/09 Nutrition Eval

6/24/09 Psych Eval

6/25/09 EKG/Stress Test/History & Physical (Cardiologist)

7/10/09 Surgeon faxed packet (Friday)

7/14/09 Approval (Tuesday)

Good luck to all those who are just beginning the process. Take control of the process and move it along .

294/294/size 12

Edited July 15, 2009 by cmedwards

[Tina254 0]

Does anyone know if this is true? I've read a couple of times here and there that for tricare you can be denied if you are under 25 years of age. Does anyone know if this is true? I'm a little scared thinking I could be denied over my age but I hope that is not the case.

[milwif 0]

Does anyone know if this is true? I've read a couple of times here and there that for tricare you can be denied if you are under 25 years of age. Does anyone know if this is true? I'm a little scared thinking I could be denied over my age but I hope that is not the case.

I've never heard this, read this, or been told this. The only thing I can think of that even remotely relates to this is that perhaps if you are under 25 you are apt to have less associated medical conditions. I for example, don't have diabetes or arthritis YET, but I'm sure without surgery, I would in the future.

I'm 21, and I got approved with no problems at all.

[Cat Martin 0]

:thumbup:I didn't know Tricare knew how to Deny anything, lol.

What base is everyone at? I would love to know if there anyone near me. Whidbey Island, WA

[milwif 0]

:thumbup:I didn't know Tricare knew how to Deny anything, lol.

What base is everyone at? I would love to know if there anyone near me. Whidbey Island, WA

My husband is in the National Guard so I'm based right here at home:smile2: I live in a small town near Salem, OR but my hubby is from Bellingham. Thats about all I know of WA, are you near there at all?

[AlaskaGirl77 0]

My best friend just almost moved to Whidbey Island...she'll be there in 2 months. She's home in WY while her hubby is at recruiter school...im up at Eielson AFB near Fairbanks Alaksa!

[Jade0729 0]

Hi guys! I swas worried about the same thing. I don't have any of the health issues Tricare requires but my cholesterol is high and I am borderline diabetic. But without surgery i'm pretty sure i will one day. I am really worried about them denying me the first time, were any of you guys denied the first time and approved the second time?

[milwif 0]

Hi guys! I swas worried about the same thing. I don't have any of the health issues Tricare requires but my cholesterol is high and I am borderline diabetic. But without surgery i'm pretty sure i will one day. I am really worried about them denying me the first time, were any of you guys denied the first time and approved the second time?

I was just sure I'd get denied and have to appeal it, but suprisingly I was approved the first time with no problem at all! My cholesterol was a little bit high, and I have sleep hypopnea which is like the beginning of sleep apnea, and thats really it. I have joint pain but not arthritis. So really I didn't have Tricare's comborbs at all. I might have squeezed into the 200% range though...I think my surgeon specified that I was small framed. I'm 5'2", and was 235 when they sent the referrel. Hope that helps!

[mmmorgan 0]

OK, so I have Tricare Standard (West) and am almost done with the whole process to submit the claim. I'm kinda nervous that it will not be approved. I'm about 87 pounds overweight and I have high cholesterol and a fatty liver (yes I have that documented). Everything else is fine. I think my BMI is just at 40. I'm so nervous I will not be approved. Any insight???

[milwif 0]

OK, so I have Tricare Standard (West) and am almost done with the whole process to submit the claim. I'm kinda nervous that it will not be approved. I'm about 87 pounds overweight and I have high cholesterol and a fatty liver (yes I have that documented). Everything else is fine. I think my BMI is just at 40. I'm so nervous I will not be approved. Any insight???

how much do you weight and how tall are you? And are you basing this off the Metlife chart? From what I've heard, Tricare is pretty strict about the 100 pound weight requirement. I know some people on here who gained a few pounds or wore ankle weights when they weight in to secure that requirement, you might look into that.

[nurse2009 0]

I have tricare reserve select. Have been researching LB like crazy and finally decided this is something I NEED! Can anyone tell me what steps to take first to get things going?

[RubyTuesday 0]

when looking at the met life chart, does tricare consider you a hundred pounds over weight from the low end of the range, or the high? For instance I'm 5'6" and 242 lbs. The met life chart says for med. frame, my weight range is 130-144 I believe...?

[RubyTuesday 0]

nurse- I think the first thing you need to do is get referred to a surgeon for a consult by your Primary Care Manager. At least with Tricare Prime that's the case. Do you get to choose your own doctors and do not have to be seen on post? If that's the case, then you don't need a referral for the surgeon and can just go, and they'll submit the paper work to get it approved through Tricare. And you can always call Tricare and ask them. They're fantastic.

[L12 13]

I have tricare reserve select. Have been researching LB like crazy and finally decided this is something I NEED! Can anyone tell me what steps to take first to get things going?

I also have TRS, and it was SO easy! I would call Tricare first to find bariatric surgeons in your area. Do your research on the doctors and their program requirements, go to one or more seminars (if offered), make your selection, and then make an appointment. You will NOT need a referral for a consult with TRS.