Here Are The Requirements For Tricare

[Kwa123 0]

I girls i have tricare standard and I have everything done we are just waiting on approval from them

Hello I am in Jacksonville FL too. Tell me who have you been seeing here in Jax that will do you surgery?

[milwif 0]

Hey Everyone, Im in CA and new to the chat. Today I had the laparoscopic, ultrasound blood work and EKG done, they gave me the paperwork for the 2 week diet prior to surgery. Question am I approved if I am having this all done. I am 35 bmi and 70 lbs over??? any help would be greatly appreciated. I have tricare prime...

I would call Tricare and/or your Dr. and ask them. I got all of my tests and my Lap Band literature prior to actually getting approved.

[mmmorgan 0]

My stuff was submitted to Tricare last Friday. It's currently in Pending Review. I'm so nervous!!!!

[mmmorgan 0]

Just found out I was denied. So I called Tricare and in the notes it said that there were no clinicals. What the heck does that mean exactly? Now I have to wait for the letter and then appeal. She mentioned writing a letter. Is there a good letter out there that I can use?

[babyka16 0]

omg! tricare is a pain! I was denied too. my letter said it was because i had no co-morbidity's! but I'm 200% over my body weight.. so i do qualify. you only have to meet one of the 3 requirements! anyway i had to go back to my surgeon and be re evaluated and have the paper work resubmitted to tricare. so lets hope this one goes thru if not i have my appeal letter ready! they just want to write a letter about how your weight is affecting your every day life. they already have your medical records sent in by the surgeon so its just a personal one from your side.

Karen

[mmmorgan 0]

After talking to my drs. office since Tricare faxed them the denial letter, I learned that I'm just not heavy enough. Sooo, what the heck. It said on there that I'm 108 pounds overweight...on the Tricare form! Plus I have high cholesterol and a "fatty liver." I'm just upset at the whole thing. If I'm "underweight" it would be easier for me to gain what I need to have the surgery than it would be to lose over 100 pounds on my own. Frankly, that would just never happen.

Just waiting for the denial letter to get to me so I can figure out what I need to do next.

[babyka16 0]

After talking to my drs. office since Tricare faxed them the denial letter, I learned that I'm just not heavy enough. Sooo, what the heck. It said on there that I'm 108 pounds overweight...on the Tricare form! Plus I have high cholesterol and a "fatty liver." I'm just upset at the whole thing. If I'm "underweight" it would be easier for me to gain what I need to have the surgery than it would be to lose over 100 pounds on my own. Frankly, that would just never happen.

Just waiting for the denial letter to get to me so I can figure out what I need to do next.

i know what you are going through! tricare did not even send my surgeon the denial letter so they had know idea why i did not get it! So they also did not even factor in that im 200% over my body weight! errrr. here is how you get it if you want to know so you can put it in your apeal. you geton the metlife webpage (metropolitalan life charts) find your ideal body frame and weight. then on the low and high end of your ideal body weight add 100 pounds to that. if your over then you make it or should. in my case im 264 so my ideal low body weight is like 127 so i add 100 that is 227 umm yeah im over! then i take the high end and add 100 so 144 pluse 100 is 244 umm yeah! so do that too also i even found it on the tricare web page that states " tricare must add 200% (or 100 pounds the the hight and low ends of ideal body weight) here is the link its long TriWest Healthcare Alliance...

let me know if this does not work and i can try to cut and past to your email or something. i know how hard this is for you and me so best of luck and i know we will both get this we just have to fight harder. sucks but what more can you do. also i found alot of help on here for apeals and what to write and add in also look on the web there is allot of stuff too. again keep me updated!

karen

[babyka16 0]

ok sorry that link does not work try this one TriWest Healthcare Alliance

[babyka16 0]

that one works sorry! hope this helps you out!

[hope2bthinr 0]

babyka16, I was just turned down for the same reason. So this is how they figure 200% of your ideal weight... if my ideal weight range on the Metlife tables is 106-118 those two numbers would be 100% of my ideal on the low and high end. So 200% would be double. The new range is 212-236 (for me I would have to weigh over 236). The high one is the one my weight must exceed. I don't know why they even discuss the low end because they only approve you if you are over the high end!! If they would explain it more clearly, they'd have a lot less paper work from people who don't meet the right number.

I went back to my Dr. since it's been 3 months since they weighed me and I now weighed in excess of the amount required so they are resubmitting. I had them add a letter from me personally telling how much my weight affects my life and my family history of diabetes, high blood pressure, heart attacks, heart failure, etc. Even though I don't have them, the evidence is there that as the 8th kid and the only one without those diseases, I will more than likely develop one or more soon. I told how much pain I have when trying to be physically active or just clean house and how depressed I am and embarrassed to go anywhere.

I hoping if there is any doubt, that it will help.

Hope this info helps you know what to do to be successful!!

Edited September 12, 2009 by hope2bthinr

[babyka16 0]

R u sure? did you check the website link to triwest and scroll all the way down and read the last few things because it does say must apply 100 pounds to the ideal weight check it out let me know what you think. lol uggg tricare lol

karen

[milwif 0]

R u sure? did you check the website link to triwest and scroll all the way down and read the last few things because it does say must apply 100 pounds to the ideal weight check it out let me know what you think. lol uggg tricare lol

karen

You can be approved by either being 200% the ideal weight with no necessary comorbs OR 100 pounds over the ideal weight WITH comorbs. It's an either/or type thing. If you're shooting to meet the criteria for 200% over ideal weight, you can basically forget about the whole 100 lbs thing. Just take your healthy weight range and double it. Thats where you need to be.

[hope2bthinr 0]

Yup, what MILWIF said! That's how it was explained to me. So I went on a "weight control" strategy....

Figure out double the high side of your ideal weight range...that's what you need to be to qualify UNLESS you have High blood pressure or one of the other conditions.

If you have one of those conditions THEN you would have to be 100lbs over your high side ideal weight.

I don't know why they can't just use BMI like the rest of ins companies!!

Anyway, good luck on meeting that weight requirement!! Maybe you can still get there.

[Jessimond 0]

I noticed you live in Colorado and your sx was done in Kentucky... have you moved since then or travel THAT far for the sx?

[mish-l 0]

hello all.. my name is Michelle and i'm new to the forum.. i was wondering if anyone here is from the ft hood tx area and if they have any advice for me when it comes to getting in touch with a surgeon around here? I have just started the process, in fact i still have to schedule my appt for my pcm to give me my referal. Also does it matter where your at whether you get approved from tri care or not ..cuz i know in ga where we were stationed last they were giving it out like candy. Girls that were like 60 lbs overweight were getting it done and covered through tricare..makes you wonder. Anyway... i look forward to getting to know y'all and appreciate any help/advice you can provide.. thanks