I GOT MY DENIAL LETTER TWO DAYS AFTER THE DOCTOR SUMMITTED 93 PAGES OF INFO .I'M GOING TO APPEAL BECAUSE I'M 5'4' 236PDS AND HAVE THYROID AND DIABEITES SO I SHOULD HAVE MET THE CRITERIA ANY IDEAS ON WHAT I SHOULD BUT IN MY LETTER. ANYBODY HAVE ANY GOOD RESULTS WITH THEIR APPEALS?:teeth_smile:

Make sure you water load and hold your purse when you weigh in and point out to your doctor that you have a small frame.

Mimi

I was just wondering your outcome. I'm in the same boat as you- I submitted my appeal letter and I haven't heard anything. I was wondering if you appeals and what happend, and how long it took? I'm so anxious to see what they are going to say about my appeal? Any help is greatly appreciated.

Can someone help out on ideas on what to put on my appeal ?

I am frustrated, as my LAP-Band procedure was denied by Tri-west today!

I did the "scavanger hunt" (PCM referral for consultation and seminar, attended the seminar, met with my surgeon, met with the psychiatrist, etc.. everyone approved for me to get my lap band surgery - except TRIWEST).

I sort of know that you either are 200% over your ideal weight, or weigh over 100 lbs plus have 1 morbid disease.. (HBP, Diabetes, etc.) to be approved for the procedure.

I am 100+lbs overweight, and with no co-morbid diseases.. However, I had Gestational Diabetes back in 2009 and had my gallbladder removed back in 2005. Have a family history of HBP, Heart attack, diabetes (granparents), and my dad actually has type 2 Diabetes. I've had anxiety attacks in the past, but other than that.. .. that's it.

Any suggestions on what to submit on my appeal ??? Referrals?? etc.. ?? I'd really apprecciate it..! Am frustrated and heartbroken! :S 2 months of doing all this .. to get a no..

I was just denied by Triwest and wondered if you received your appeal letter from SuzanneG if you did do you mind emailing it to me I have no idea where to start with this letter. matthewtotoro@hotmail.com

good luck with your appeal

Hi Suzanne, I was recently denied for surgery on July 2nd due to not enough medical need. I am 5'4 and weigh 232lbs. I am in need of help with the denial letter. Can you send me what you have? my email is roshunda.hamilton@yahoo.com Thanks

please share appeal letter bmxmomla@aol.com Tricare keeps denying me

please share appeal letter bmxmomla@aol.com Tricare keeps denying me

please share appeal letter bmxmomla@aol.com Tricare keeps denying me

why are they denying you?

My wife recently received a denial from TRICARE for gastric bypass. The reason being is that she had lap band surgery some 8 years ago and it was not successful. The lap band did not set right on her stomach and the doctor recommended it be removed and that gastric bypass surgery be performed at the same time. TRICARE denied the authorization for gastric bypass because she had the lap band surgery. I realize that TRICARE only authorizes one weight loss surgery in a lifetime, but the kicker is that we did not go through TRICARE for the surgery and we paid totally out of pocket.

Anyone have any thoughts on how we can appeal this denial?

Like I said, my surgeon and his office do not think I will be denied. BUT, just in case, I am getting my appeal letter ready!

What are you being denied? I see you had been banded and lost a lot of weight.

I had to appeal my Tricare denial SIX times. Finally I found out a specific place to send it