Tricare Approval or Denial??

[Jewlo 0]

WOw I can't believe how smoothly everything is going... Was Approved for everything so far. :rolleyes2: They sent all the information to Tri-Care on Friday I just hope and pray for them to cover it !! I have my fingers crossed !! :hurray:

[Maggies 0]

Jewlo, good luck on your approval. I was denied at first and had to appeal which was approved. I was just banded this past Wednesday and still a little sore. Let us know how it goes. Maggies:shades_smile:

[JamieNP 20]

Does anyone know if you can change the polls? I am the starter of this thread and I thought you could change your options.

[teambrooks2 0]

Has anyone been approved in Nevada by Tricare? Small Naval Base not sure the PCM's have any idea about the surgery?:tongue:

[DJ53 0]

I have tri care standard which does not require pre approval. I am borderline and I worry that after doing pre op diet I will not qualify. The dr. can not give me any info. I am worried that I will end up with a huge bill if my ins does not pay. any advice.

[L12 13]

I have tri care standard which does not require pre approval. I am borderline and I worry that after doing pre op diet I will not qualify. The dr. can not give me any info. I am worried that I will end up with a huge bill if my ins does not pay. any advice.

Tricare Standard does not require a referral, but if you want them to cover it they will still have to authorize the surgery before it is performed. I believe most doctors use the weight taken at the first appointment for submission to the insurance. My doctor doesn't recommend his patients begin the preop diet until they get insurance approval though (unless a 6 month diet is required, which it isn't with Tricare). If you're borderline, begin to lose before insurance authorization, and then get denied, then you might be out of luck for an appeal since you might not weigh enough :rolleyes2:

[Jewlo 0]

Well I got TURNED DOWN :frown: They said it's because I am 13lbs to light. Can you believe that? I have everything else though. They said I can pay cash but I am not sure how I could get the loan.. I am going to Appeal anyone have any advice for me?:thumbs_up:

[JamieNP 20]

Well I got TURNED DOWN :frown: They said it's because I am 13lbs to light. Can you believe that? I have everything else though. They said I can pay cash but I am not sure how I could get the loan.. I am going to Appeal anyone have any advice for me?:thumbs_up:

Same thing happened to me...I gained the "6.5 lbs", went in and reweighed. Surgeon's office resubmitted the weight and I got approved. The only thing that is holding you back is the 13 lbs!

[teambrooks2 0]

Hi, I'm going to see my PCM today to ask for a referral to the Bariactric Center. I have attended a seminar it was great! Does anyone know what I need to ask for other than the referral?

[JamieNP 20]

Go ahead and see if they can draw labs ( a BMP and CBC, lipid profile) and do an EKG. If you can, go ahead and schedule your psy eval. Usually it is self refer but it takes awhile to get in.

Good luck!

[munger 0]

How tall are you and how much do you weight? I am 5'6" and weight 247 - I am pending approval from TriWest. I have high blood pressure and High colesteral.

[munger 0]

how tall are you and how much do you weight? I was turned down the first time - I'm not sure why.

[JamieNP 20]

5'5 and my weight was 222...then had to gain 6.5 lbs so I got up to 233. I have sleep apnea (on cpap) and hypertension).

Your denial letter should have said why you were denied. They go by the medium frame of the met life chart.

[munger 0]

All it stated was factual deniel. So I guessed that either I was under weight ( I was right in the middle of the medium section for being 100 lbs over weight) or that I my meds for high blood pressure was not documented. So I had them record my weight and BP for a week - had my Rx refilled and resubmitted. It has been over 30 days and I still do not know anything new!!!

[Jewlo 0]

I weigh 210lbs and Im 5'0.. I have not recieved my denied tricare paper yet cause I'm at Disneyworld lol... I am thinking about paying out of pocket for the lap band...