Tricare Denial..REVERSED!!

[afmomofthree 6]

I have set up my appt with my PCP for the blood pressure issue. What ticks me off is we discussed my bp on last visit which was 151/98 at the time, and she didnt even document the discussion of bp meds. On my visit note it says no blood pressure issues!!! I still haven't gotten my denial and appeal in the mail. I'm anxious to get it started. Time is weight!!! I am trying to work on my letter on how the weight impacts my life. Any suggestions would be greatly appreciated.

[munger 0]

Thanks - I just thought I had pissed them off and they would not update my stuff. I worked with the rudest lady at the TMA - Bridget - she lied - she would not return my phone calls. And the people here at Ft Huachuca - know nothing! I am glad I got approved - mainly so I do not have to deal with them anymore!!!

[jillcvt 0]

hey congrats on the approval... what is TMA? I have tricare and my first appt with the dr is tomorrow.

Jill

[munger 0]

You don't want to know - it is when you first appeal does not work they send the next one into a black hole they call the TMA - something Management Activity. The one for TriWest in in Aurora Co - and they basicly have as long as they want to "deal" with your paper work mine took from Aug 17th until Jan 14th - they do not have a 1-800#, they do not have a fax, they are simply a bunch of lawyers and their groopies that really hate passing out money.

I will remind everyone if dealing with Tricare - make sure your bone/ body frame is stated, your weight according to MetLife NOT YOUR BMI, and any co-morb are documented with meds!!!

Good luck!

[KarinaM 0]

Thanks - I just thought I had pissed them off and they would not update my stuff. I worked with the rudest lady at the TMA - Bridget - she lied - she would not return my phone calls. And the people here at Ft Huachuca - know nothing! I am glad I got approved - mainly so I do not have to deal with them anymore!!!

It SUCKS TMA lady was rude with you. I was very lucky with my lady Erika. She called me gave me her number called me when I was approved. My main problem ws always TRIWEST people know NOTHING they are stupid and I had to tell them all the time what was going on.

[afmomofthree 6]

Well...l didn't have much luck with my PCP yesterday. I believe she's been burned regarding the lap band. I see a dr on the nearest navy base and she wasn't helpful at all. She was the one that suggested the lap band and started the ball rolling but as we went along she started changing her story. In November we had gone over my bp being a little elevated. She didn't want to address this because she thought I would be approved for the lap band. Anyway, I saw her yesterday and informed her I had been denied. As soon as I said this she automatically started telling me she couldn't help me and she was sorry I didn't get approved. When we discussed my bp she still doesn't want to address it because she said diet and exercise will fix it. I have had chronic low back pain that has hindered me from exercising. The MRIs haven't shown anything. I left there yesterday nearly in tears because she didn't want to do anything to help me. I'm at a loss. I want to appeal but don't know what to do now. I am working on a personal letter about how it affects my life but I'm sure that won't be enough. Does anyone have any suggestions. I just don't want to be miserable anymore.

[KarinaM 0]

Well...l didn't have much luck with my PCP yesterday. I believe she's been burned regarding the lap band. I see a dr on the nearest navy base and she wasn't helpful at all. She was the one that suggested the lap band and started the ball rolling but as we went along she started changing her story. In November we had gone over my bp being a little elevated. She didn't want to address this because she thought I would be approved for the lap band. Anyway, I saw her yesterday and informed her I had been denied. As soon as I said this she automatically started telling me she couldn't help me and she was sorry I didn't get approved. When we discussed my bp she still doesn't want to address it because she said diet and exercise will fix it. I have had chronic low back pain that has hindered me from exercising. The MRIs haven't shown anything. I left there yesterday nearly in tears because she didn't want to do anything to help me. I'm at a loss. I want to appeal but don't know what to do now. I am working on a personal letter about how it affects my life but I'm sure that won't be enough. Does anyone have any suggestions. I just don't want to be miserable anymore.

Let me tell you something: YOU HAVE TO BEAT THE SYSTEM. If this PCM will not helpyou got to another one and tell this new one you have HIGH blood pressure, back pain .... If you have to go for the 200% over the weight table DO IT, I did it. I "added" 30lbs under my clothes and appealed and it worked Got my RNY Jan 26 after 6 months fight with Tricare. Do whatever it takes and do not give up.:mad2:

[afmomofthree 6]

I finally got my denial reversed! I'm still kind of in shock at the moment. I just found out on May 5th and they've already got me scheduled for surgery on May 19th! Not quite prepared because I didn't expect it to happen that fast after submitting the appeal. It took all of 89 out of 90 days to submit it but so far, it's worth the wait.

[kinseeker 0]

Does anyone know if Tri_care reserve select requires a 5 year weight history? I can't provide this due to I just got insurence. I have not been to the doctor since 2007. I did have my son in 2007 but my husband was active duty at the time and I don't have my health records from that. Has anyone been able to get the lap band without the 5 year history?