Tricare Approval or Denial??

[L12 13]

I have Tricare Standard and my Dr. indicated there might be a 6 mth diet waiting period. Has anyone else had to wait six months with Tricare?

Tricare does NOT require any type of diet prior to approval. However, that doesn't mean the doctor can't require it for his/her program.

[brat7169 0]

Thanks for the reply. I think you are right that my Dr. confused Tricare with another insurance. I really don't want to wait six months. Thanks again!

[delta27 0]

I am not sure if anyone is still reading this thread but I have been APPROVED:thumbup::thumbup::thumbup::sneaky::sneaky::thumbup:; I had to appeal but I faxed the appeal in with documentation and it was approved within 3 days. I get banded January 8th. YEAH!!!!!!!!!!!!!!!!!!!!!!!!!

[JamieNP 20]

What a wonderful Christmas present for yourself! Congrats! It has been over a year for me and I am down 87 lbs. 10 lbs from my goal

[two4tea 0]

The time it took from start to finish to get approved for RNY was less than 3 weeks. That was not including the time I had to wait for the appointment to speak with my pcm about getting a referral.

After I spoke to her and she put in the referral it was really fast! It took a few hours for my referral to pop up on triwest website approved. HOURS not days.

went to all the appointments and then my surgeon put in the letter of medical necessity (civilian surgeon) and I had an approval in a day!!!

I was 100 lbs over the recommended healthy weight on the met scale that tricare goes by. I needed to be between 113-126 to be a healthy weight, I was 213 so I was exactly 100 over.

I did have high cholesterol and my blood pressure was starting to edge up to the higher end of the scale. I was prescribed blood pressure pills but I only took them as needed when I felt anxious.

I did have a sleep study done to see if I have sleep apnea but we ended up submitting the paperwork without the results because if we waited for them it would add another three weeks.

I am on a time crunch because I am trying to get the surgery done before my hubby deploys in a little over a month and we needed to give me enough time to recover with him here, so we were in a hurry.

Even without the sleep study results, I was approved. Oh yeah and when I did get the results back I found out that I do have sleep apnea. It will go away as I lose weight.

[Psue 0]

Tricare has been awesome. I used to have Aetna and their list of requirements is long and painful:bored:. Tricare was just a referral from primary physician and a pysch eval. I was approved less than 24 hrs after paperwork was submitted! My surgery is April 5th and I am so excited for this new chapter in my life to begin:thumbup::frown:.

[Rsilversea 2]

My surgeon sent my info to Tricare yesterday. I'm waiting on approval now. If I get it, my surgery is scheduled for May 5th. Hubby has appeal letters waiting in case they deny me (he worries about things more than I do).

[mrscat 0]

I was denied!!! I am really upset about this. My Dr is going to call to see what is missing. I will call back in the am to see what I need to do. I am so sick of Tricare. It really makes me mad that a total stranger decides what is best for me!!!

[Rsilversea 2]

The most frustrating thing about Tricare is their lack of consistency. Some people are approved or denied based on BMI and others have to go through old standards. I just talked to my husband who e-mailed my doctor the Tricare policy because Tricare is trying to hold me to the old standards. I had to get re-measured and reweighed today PLUS I have to get x rays done on my knee and ankle to see if I have osteoarthritis. Apparently my other co-morbidities are good enough for Tricare. Heaven forbid I'm trying to better my health and keep them from paying out more money later for other surgeries and medications. (rant completed)

[Felisha 0]

Okay.. Med frame weight for 5'2 is 118-132...

My weight at the DRs today is 237.. That divided by 2 is 118.5... Making me meet the 200% by .5 lbs.

Should I pack on about 10lbs JUST to be safe???

[Rsilversea 2]

Well, as I stated in another thread, I was denied but my doctor is going to call Tricare. I've been told that once the doctor has spoken with insurance companies, they usually give approval. I hope so since I've been stressed out about this.

[Felisha 0]

I'd appeal!!! Don't give up!!

[Rsilversea 2]

So po'd! My doctor's office never measured my height so I was denied by Tricare. Now I'm officially 12-20 pounds under their current standard for surgery approval. It doesn't look like I'll be getting surgery done even though my BMI is 40 because Tricare is behind the times with the rest of the nation. They still use the outdated MetLife height/weight chart! Spitting mad and depressed. Hubby just wants me to lose it on my own and can't comprehend how difficult that is for me. So now we are arguing. He thinks I'm giving up on losing weight (and he may be right). I can't reach my nurse at the doctors office and don't know what to do.

[Felisha 0]

Weights or huge HUGE Huge meal and weigh again?

[Rsilversea 2]

Doctor's office is sending in appeal today. They are using the weight I was when I was first weighed and my correct height. Haven't received my denial letter so I haven't sent in my appeal. Hopefully I'll have good news by the beginning of next week.