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Anyone........willing to share TRICARE appeal letters

Nume31

By Nume31, in LAP-BAND Surgery Forums

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Nume31    1

Nume31
Posted

Hey ALL

Well this process is DRIVING ME NUTS! I have 2 insurances...one pays the other does not....Doc MUST bill one for denial before other will pay. Tricare is 2nd to employer insurance

I am 100lbs overweight....however I don't have any co-mobilites ( blessed)...and I am feeling like this might be a sticky problem for me.

Is there anyone who has written an Appeal letter to Tricare that was successful in getting approval and will to share : )

I am preparing " is case" this becomes a small issue for me : ) also any advice would be helpful as well!

Thank you in advance!

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Rsilversea    2

Rsilversea
Posted

I won my appeal with Tricare. I had to have my Tricare rep duke it out with the case worker though because I was also 100 pounds overweight with no comorbidities. Apparently they were interpreting their own rules wrong. Tricare has since changed it's rules. Don't worry about a denial yet. If it does happen, find out why they are denying it and have your local Tricare rep and doctor help you with an appeal.

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Nume31    1

Nume31
Posted

Wow really....thanks for NOT being supportive! I have read several posts that were similar to mine and they appealed and got an APPROVAL. Trying being more supportive when you reply to a post......

You will not win an appeal,,,the standards are followed strictly. Sorry.

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Nume31    1

Nume31
Posted

Thank YOU! I will wait it out and see...I am bitting my nails just waiting for a response...I will keep you posted

I won my appeal with Tricare. I had to have my Tricare rep duke it out with the case worker though because I was also 100 pounds overweight with no comorbidities. Apparently they were interpreting their own rules wrong. Tricare has since changed it's rules. Don't worry about a denial yet. If it does happen, find out why they are denying it and have your local Tricare rep and doctor help you with an appeal.

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Mimilou2004    13

Mimilou2004
Posted

Wow really....thanks for NOT being supportive! I have read several posts that were similar to mine and they appealed and got an APPROVAL. Trying being more supportive when you reply to a post......

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Mimilou2004    13

Mimilou2004
Posted

Wow really....thanks for NOT being supportive! I have read several posts that were similar to mine and they appealed and got an APPROVAL. Trying being more supportive when you reply to a post......

I will post what I know....supportive pap or not...I have NEVER heard of anyone winning an appeal in my area without a co-morbidity showing up. I actually hope you win, even though you are a snotty acting poster. Stick around a few years and learn something.

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Rsilversea    2

Rsilversea
Posted

Usually I ignore crap like this since it's not worth my time but I have to agree with the OP. You may not have meant to sound like it but it came across as "snotty". And so did your reply. I'm sure you know people who have not won appeals but there was a better way of putting it than "You won't win." As I stated, I did and so have many others on this site. "Stick around a few years and learn something." That there are snotty posters out there? I'm sure if the OP has read this board then she knows that there nasty people out there. Nume, keep your chin up and don't fret. As I said, you haven't been denied yet. If it happens, your doc and your rep will be able to help you out.

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Go To Topic Listing LAP-BAND Surgery Forums

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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      1. summerseeker

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        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

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        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

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