Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Tricare Approval or Denial??



Did you get approved by Tricare?  

7 members have voted

  1. 1. Did you get approved by Tricare?

    • Yes, I got approved. No problems.
    • Yes, I got approved and I was borderline the weight requirement
    • Yes, I was approved, only after I appealed.
    • No, I was flat DENIED.
    • No, I was denied and I did not try to appeal.
    • No I was denied, even after appeal.
    • I am waiting on approval.


Recommended Posts

Well, I meet the weight requirement and was already weighed in at my consult. The problem I have is with "documented" co-morbids. I have them I'm just not being treated for them and that is why I'm going to PCM for meds for these conditions. I just hope she doesn't give me the run-around about how it would be best if I just lost weight and didn't take meds! I'm not leaving without meds!

Share this post


Link to post
Share on other sites

My surgeon just weighed me but this was just a suggestion for someone who may be at the end of their rope and desperate.

Hope everyone is doing well on the band journey.

Share this post


Link to post
Share on other sites

I have comorbids, back pain and joint pain. Only med I'm taking is a steroid (which I use every once in a while). I didn't have anything else documented with my PCM but I got the approval.

Cobrien ~ I think the problem may lay with the surgeon you have chosen if they don't write a strong enough reason for the surgery you will get denied.

Share this post


Link to post
Share on other sites

I am so excited! My surgeon's office finally submitted everything, and I am "PENDING" right now...could be any time now before that changes!!

Share this post


Link to post
Share on other sites

JWRN, Hope you get your approval soon. I have my first appt. with the surgeon on the 21st. Hopefully he will get the paperwork in to Tricare and I will here something by the end of August. Let us know when you get your APPROVAL and date. Maggie:cool2:

Share this post


Link to post
Share on other sites

I had my papaerwork submited on friday but they needed a referal form filled out and the Dr.'s office faxed late friday. Yesterday was showing pending online and today I was told they needed more "clinical information" from my Dr. I called the surgeon coord and she told me she had NO TIME and she would send it to Tricare WHEN SHE HAD TIME. In the mean while I'm ready to have a stroke, I check the Tricare online every 5 min, I can do or think about anything else. I wonder if the fact they need more info it is a good or bad thing....

Share this post


Link to post
Share on other sites

I am still pending. I called Tricare today and they said that it has not been reviewed yet. Argh!! Waiting is the hardest part!!

Share this post


Link to post
Share on other sites

I too have Tri Care and I go to my PCM on Thursday of next week to get a refural or a surgeon.. I then have a class on Tuesday the 26th.. I hope tri care is fast:unsure:...

Share this post


Link to post
Share on other sites

Called Tricare again and they told me the Dr's office did not fax the info they need YET. I called the lady and after 10min waiting they told me to leave her a message. If she does not called me with in 3 hous I will be going over there and ask to fax my self. Is this to extreme??????

Share this post


Link to post
Share on other sites

Go for it Karen! What do you have to lose? (well, they could send you in for another Psy exam, :tongue_smilie:

I am still "Pending" on the Tricare site. So I called Tricare to see what was going on. Apparently they have sent it to the post hospital (which I have never had anything to do with, and my surgeon is not there) and they have to refuse it first and then it is sent out to a local surgeon. She said that usually that means I am approved. I should find out something officially tomorrow. So, I am thinking..does that mean I am approved?!?!?! The soonest that my surgeon can get me in is Sept 23. I guess I am a control freak...the waiting is KILLING me!!

Share this post


Link to post
Share on other sites

I know, I think you were approved by what they told you. I'm also a control freak and I think I am getting everyone insane at Tricare and also at the Dr's office. Can you imagine my family? I just want an anwer and NEED to be the A letter. Let me know as soon as they approve you. I think my surgery in case I get approved will not be until end September because my Dr. is very busy. As long as I get this before October, I'm happy. GOOD LUCK.

Go for it Karen! What do you have to lose? (well, they could send you in for another Psy exam, :tongue_smilie:

I am still "Pending" on the Tricare site. So I called Tricare to see what was going on. Apparently they have sent it to the post hospital (which I have never had anything to do with, and my surgeon is not there) and they have to refuse it first and then it is sent out to a local surgeon. She said that usually that means I am approved. I should find out something officially tomorrow. So, I am thinking..does that mean I am approved?!?!?! The soonest that my surgeon can get me in is Sept 23. I guess I am a control freak...the waiting is KILLING me!!

Share this post


Link to post
Share on other sites

Well I was told I should hear something tomorrow or Monday. However, I'm not getting my hopes up even the nurse at my surgeon's office said it might not be likely that I will get approved. So I don't know what to do now. However, if I am approved the surgery won't be until NOVEMBER!! UGH!

Share this post


Link to post
Share on other sites

Well I was told I should hear something tomorrow or Monday. However, I'm not getting my hopes up even the nurse at my surgeon's office said it might not be likely that I will get approved. So I don't know what to do now. However, if I am approved the surgery won't be until NOVEMBER!! UGH!

why all the way untill Nov?

Share this post


Link to post
Share on other sites

This is the only city in the state of Montana that does lapband and there are only 3 surgeons here so, it's busy. My dr. is the most popular out of the 3. If I get approved I could be moved up though. But like I said before I really don't think that will happen since the dr.s at the base are being assholes about this.

Share this post


Link to post
Share on other sites

Well I was told I should hear something tomorrow or Monday. However, I'm not getting my hopes up even the nurse at my surgeon's office said it might not be likely that I will get approved. So I don't know what to do now. However, if I am approved the surgery won't be until NOVEMBER!! UGH!

Why is she telling you you are not gettin approved? Are you way under weight??? They should not tell you that.

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

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • 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.
      · 0 replies
      1. This update has no replies.
    • 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

        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

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

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
      · 0 replies
      1. This update has no replies.
    • bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
      · 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

    ×