Denied by TriWest Prime

[munger 0]

Hi, I started this process at the end of July! I thought I had dotted all my "i's" and crossed all my "t't" BUT I still got denied.

I am 48, 5'6", 247 pound, high blood pressure and colestral(400+) on meds for both, and have been recommended for back surgery because I have degenrative whatever! I was turned down in a matter of days by the people in Arizona. I got my paper work back and sent it to Colorado - after they had my package for 2 weeks they finally sent me a letter stating that it was on someones desk. Now that has been over 2 months! So I figure I have 30 more days to wait to get my - third deniel!!

C

[LISAMARIE1158 0]

NEVER GIVE UP....you are worth the wait

[Mimilou2004 13]

Munger, you have to be at least 100 lbs overwt for Tricare. I don't think you are missing it by much. Find out exactly why they are turning you down, you have the rquisite co morbity. Best wishes. Oh, there are several tricare threads here.

[karen_karen 0]

hi i have tricare south and i too was denied the first time. what i did was get a recommendation from my pcp and also from the doctor that did the surgery and i also wrote them a letter about why i needed the lapband. and within a few weeks i got it approved. also you have to have a bmi of 40 and i had to gain a bit of weight to make it so you might want to do that as well.

[munger 0]

Going by the chart I am 100 pounds over weight!! I am medium frame, so at 247 that puts me over wieght for even a large frame woman. The reg states that they have to add 100 pounds to both the upper and lower end of the weight chart. Unless I am reading it wrong!!!

[Maggies 0]

Munger, I am also 5'6 and I weight 258 when mine paperwork was first submitted. I was denied, until my surgeon discovered that my tests showing that I have sleep apnea was not sent to Tricare. So the surgeons office resubmitted it and I was approved two weeks later. What did your denial say was the reason for being denied??? Keep trying and you will be approved. Maggies:shades_smile:

[munger 0]

It was a factual deniel - I guess it means that I did not meet the requirements. Nothing else was stated. I was kinda left hanging. I did get an e-mail from someone at Triwest - and they could not figure out why I had been denied either - by looking at the requirements and was told to appeal.

[karen_karen 0]

i say do your appeal and also write a letter to them about why you need the lapband. i was 5ft7in and i weighed 265. keep trying and appeal because it is totally worth it. i got banded in the beginning of july and im down to 205. dont give up

[munger 0]

The letter is the appeal - I think. I wrote a letter and then also went and got my weight and blood pressure checked for a week and sent that in also. It has been over 30 - and still no word. So I am not sure if I did it correctly.

[Brandy~ 2]

I am sorry to hear they are making it so rough on you Munger :rolleyes2: Have you tried calling them recently?

[munger 0]

The people in Aurora "don't have a phone" nor do they have a fax!!!!