Im so disappointed I found out I was denied by Triwest for the band they called it a "factual denial" then they were telling me who qualifies. They said I didn't meet the qualifications but I clearly do I can't understand why I wasn't approved it just doesn't make sense. I will appeal and see what happens I guess.

Sorry to hear that. Definitely appeal!

Denifnately appeal!!! I was denied last July and I already had a surgery date....was so disappointed. I appealed and was approved this March. It was a long wait but now I am getting the band this July 25th. Had to wait for the summer when I had time off. Hope it is worth the wait.

Im so disappointed I found out I was denied by Triwest for the band they called it a "factual denial" then they were telling me who qualifies. They said I didn't meet the qualifications but I clearly do I can't understand why I wasn't approved it just doesn't make sense. I will appeal and see what happens I guess.

you are over 41 BMI ? whats the problem? did you ask your surgeons office they usually know what needs to get fixed

They denied me at first saying I was doing it for looks because I didn't have any medical problems at the pre approval part , after all my testing , they found I had serve sleep apnea and was approved

Denifnately appeal!!! I was denied last July and I already had a surgery date....was so disappointed. I appealed and was approved this March. It was a long wait but now I am getting the band this July 25th. Had to wait for the summer when I had time off. Hope it is worth the wait.

Hi Cat Lady,

I too am getting my op on the same day with the same DR, Are you going to the meeting this Tue the 19th?

If so would like to meet you and say hello.

Small world.

Mary

So Im still waiting to find out what the deal is with Tricare. Called the surgeon havn't heard back and I called Triwest and they couldn't give me any further details as to why I was denied. Havn't received my denial letter yet but I know its coming so I need to get busy on my appeal letter.

Im trying to gather all my medical records into one file. I didn't realize that they "retired" your medical records if you don't see anyone on base for 3 years. Now I have to get those files from St. Louis and was told it would take anywhere from 4-52 weeks to get them. We will be leaving here in December I hope its sooner than later.

My friend who also has Tricare was denied for a breast reduction only to find out they made a mistake in submitting the paperwork.

UPDATE....Im APPROVED as of this morning. WOOT WOOT

After I was denied the reason was cause I didn't meet criteria for the approval but I clearly did. So we resubmitted and the insurance lady (Lisa) wrote them a letter stating that I do meet the requirments and to see attached paperwork from my pcm and the surgeon. In less than 24 hrs I was approved how amazing is that!! Clearly the right person got a hold of it this time and saw the mistake. I cried I was so excited. Don't have a surgery date yet but Im looking forward to getting that in the next few days.

For those who are still appealing your denials have faith and NEVER give up...you are worth it!!

Excellent news!!!! Congratulations!

Mimi

Congrats on the successful appeal! I have Tricare as well but I am part of the South region and I understand they are much faster with approvals than the rest of the regions. (Go figure? ...you'd think everyone would get the same service!)

Im so disappointed I found out I was denied by Triwest for the band they called it a "factual denial" then they were telling me who qualifies. They said I didn't meet the qualifications but I clearly do I can't understand why I wasn't approved it just doesn't make sense. I will appeal and see what happens I guess.

oh I am so happy for you!! I am still waiting for word on my appeal!! Congrats

I am appealing as well! Congrats! U give me hope!

I am appealing as well! Congrats! U give me hope!

Dont give up Kat.....I got approved after a Level 2 Appeal. If you don't succeed with the first appeal try again! Make sure you have drs letters to back you up and say it is a medical necessity. Be careful with your wording. good luck CAT

Being in the medical field and having to deal with insurances. It has a lot to do with having the proper wording on the forms. You may qualify and meet all the requirements but if the doctor's office forget to check something you are denied. It is alway a good idea to appeal and to talk to the requesting provider to make sure the paperwork was filled out throroghly