Does anyone have a detailed I guess EOB regarding weight loss surgery approval and denial from Tricare (more specifically Tricare East/Humana). I know what their website says, but it doesn’t give much info at all. Thanks!

I just got approved from Tricare East. No problems at all

I had surgery in April Tricare Prime. It was a pain but luckily my PCM made monthly appointments with me as well as all the surgeons required appointments and nutrition apts. they denied it stating there wasn’t enough information or comorbidity(bmi was over 40 so none were required) from monthly visits when my surgeons submitted it. Thankfully we had my PCM notes. The best part was the surgeon scheduler told me she just submitted one a few days before mine that had less info and it was approved so I think it depends on who actually reviews it! They dont even follow their own policy