Starting to loose hope.

[kaitlynmarie93 0]

So after all this time, waiting thinking this will finally be it, I found out today that Tricare has denied my appeal. I was first denied due to lack of information, but this time we were able to get more documentation to send in and I even had a letter of medical neccesity from my pcp. The letter I got form Tricare stated that one of my reasons for being denied again is because its not a procedure covered by Tricare?! It also stated that I have no severe comorbities as of yet but they could arise in the future. The thing that I really dont get is that I'm only 5'1 and weigh 271 pounds. I am concidered small frame and in one part of my denial letter it even states that my health records show I have reached full statue so Im not going to get any taller either. I thought they approved you if you meet the 200% per Met Life table for height and weight??? Im so confuse, upset and I dont know what my other options are.:smile:

[Stacy1980 0]

So after all this time, waiting thinking this will finally be it, I found out today that Tricare has denied my appeal. I was first denied due to lack of information, but this time we were able to get more documentation to send in and I even had a letter of medical neccesity from my pcp. The letter I got form Tricare stated that one of my reasons for being denied again is because its not a procedure covered by Tricare?! It also stated that I have no severe comorbities as of yet but they could arise in the future. The thing that I really dont get is that I'm only 5'1 and weigh 271 pounds. I am concidered small frame and in one part of my denial letter it even states that my health records show I have reached full statue so Im not going to get any taller either. I thought they approved you if you meet the 200% per Met Life table for height and weight??? Im so confuse, upset and I dont know what my other options are.:smile:

Hi there. I am sorry you are going through such a hard time. I have Tricare and i am in the middle of the approval process but I have done a lot of research wtih Tricare and according to their stardards..you do qualify. Have you seen the paper work that they received? Is it possible that the height, weight BMI is incorrect?? I would not loose hope. I have met a lot of people on this website as well as on the gastric bypass site that had to appeal few times and they got it at the end.

I hope that it works out for you and don't take "no" for an answer.

[Padanelle 2]

... my health records show I have reached full statue so Im not going to get any taller either. :smile:

Hi Kaitlyn,

May I ask how old you are? Some insurance has a minimum age limit. If this is not the case, I agree with Stacy. Definately continue to fight it.

Good luck.

Joan

[L12 13]

Tricare was SO easy for me and many others, and since you seem to meet the requirements, the only thing I can think of is that your doctor's office must have an error somewhere. Tricare can make mistakes, but they've received your info twice; I just think it's unlikely that they'd process it incorrectly both times. I would be talking to both the doctor's office AND Tricare...

[hope2bthinr 0]

I was approved after being denied the first try. I wrote an appeal letter giving additional details on how my weight affects my life and limits my activities. I double checked the information sent in by my Dr, and made sure info was included from my chiropractor saying how many times I had seen them for back pain (I don't take a lot of pain meds since I prefer to try to fix the problem instead of only dealing with the symptoms). In the letter, if you write one, make sure you state your stats, ht, wt, bone structure, and include the metlife ht wt chart for ideal wt with your ideal wt circled. I even calculated 200% of the high end and put it on the paper. Make sure it sounds like you have been well informed as to what the requirements are, what the procedure is all about, what the risks are, etc. My appeal took about 10 days to finally get approved for authorization. With your stats I can't help thinking that either there's a mistake or your age is keeping you from qualifying. Tricare seems to be pretty rigid on their guidelines.

I almost forgot, read your denial letter and find out what it is they are denying you for and that should point you at what has to be addressed/corrected, etc. Details, details, details!!!

Keep trying and don't give up!!!

Good luck!!

Edited October 5, 2009 by hope2bthinr

[L12 13]

Oh...I just saw your age in a previous post. This could be a reason for denial, though I haven't seen anything in writing for WLS. I saw in a few places that Tricare covers "age-appropriate" things, so maybe they don't consider this appropriate for your age. How did your doctor determine that you were full stature? I didn't reach my full height until about 19.