Jump to content
×
Are you looking for the BariatricPal Store? Go now!
$99 Yearly Supply Alert! 🎉 "1 per Day!" Bariatric Multivitamins

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

Nume31

By Nume31, in LAP-BAND Surgery Forums

Recommended Posts

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!

Share this post

Link to post
Share on other sites

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.

Share this post

Link to post
Share on other sites

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.

Share this post

Link to post
Share on other sites

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.

Share this post

Link to post
Share on other sites

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......

Share this post

Link to post
Share on other sites

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.

Share this post

Link to post
Share on other sites

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.

Share this post

Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Go To Topic Listing LAP-BAND Surgery Forums

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • LeighaTR

      LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
      1. This update has no replies.
    • 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.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • 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.
      · 1 reply
      1. summerseeker

        summerseeker

        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.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        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.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    Bariatric Forums

    For Patients

    Health Professionals

    Search Surgeons

    Bariatric Surgeons: Want to research a weight loss surgery surgeon? Enter their last name below to start!

    ×