Tricare Approval or Denial??

[JamieNP 20]

It is behind a little...it didn't show up until at least 24 hours after I knew I was approved.

[aculberg 0]

Did anyone here actually have tricare call them. I had read in earlier threads that someone from Tricare called to let them know they were approved and asked if there was anything they need to call them. They never once called me.

Yeah, that was me :confused: A very nice woman from Tricare called to give me the "good news" as she put it, and was very sweet and genuinly happy to give me the news! Its amazing how different each Tricare employee can be...

[mljalways 1]

Karina............... do they tell you why you were denied?

[JamieNP 20]

I can answer that for you. They send you a denial letter and it will state why you were denied. I was denied and they said, in so many words that, Yes I had the comorbidities but the weight required for my height was 227 and my weight was 220.5.

I ended up reweighing and got approved.

[mljalways 1]

Thanks, I should be submitting for approval next week and just want to be prepared.

[allielee 263]

I was denied.. I was 125 pounds overweight with no health problems. I ended up self paying instead of waiting for a health crisis. :rolleyes2: But I have to say it is the BEST $18,500 I have ever spent!!!!!!

[JamieNP 20]

Thanks, I should be submitting for approval next week and just want to be prepared.

Don't go on a diet until you get approved. You may have to gain just a few lbs if you are borderline (remember, I was 6.5 lbs under the med frame requirement).

[tomatogirl 0]

I am just so angry...

I've been calling all week about my paperwork being accepted. I kept getting told, "we've recieved it, it just hasn't made it's way into the system." When I questioned it, they would give me the same crap about it takes blah blah blah, give it time, blah blah blah. Anyway, today I called and I got mad. The girl said she didn't know why it hadn't been accepted, so she transferred me over a different dept and they couldn't tell me why it hadn't been accepted either. I was on the phone for a total of 35 minutes (thank goodness for Cars to entertain my son), but by the end of the conversation, my paperwork has been accepted and now I'm waiting on approval.

[JamieNP 20]

I hated that run around. Good luck and let us know when you get approved. I am going to my surgeon to day for my preop and then to the hospital for other tests..just 4 more days!!

[mljalways 1]

Can someone tell me where online I can check on my request for surgery with Tricare??

Thank you

[Maggies 0]

mljalways, I live in California so I go to Triwest.com. Since you live in Florida it could be Trieast, not sure but worth a try. Then go under beneficiaries, then my account. You will probably need to set up a user name and password. Then you can check your claims and referrals.

Maggie:regular_smile:

[KarinaM 0]

mljalways, I live in California so I go to Triwest.com. Since you live in Florida it could be Trieast, not sure but worth a try. Then go under beneficiaries, then my account. You will probably need to set up a user name and password. Then you can check your claims and referrals.

Maggie:regular_smile:

HI Meggie, did you decided to do the appeal? I had the surgeons coord call Tricare and they told her the same thing I was told PENDING REVIEW and they told her usualy they take 30 days or up to 60 days. (TriWest sucks)!!!!!:thumbup:

Lrt me know if you need help. Our friend JWRN is banded by now. I'm so happy for her.She was a great help and support for me.

[Maggies 0]

Karina, I haven't heard anything from the surgeons office. I am going to call them tomorrow morning if I don't hear anything today. It has been almost a month since you put your appeal in. So maybe anyday now???? I wonder how JWRN is feeling by now. Hope she posts today.

Maggie:shades_smile:

[mljalways 1]

Yeah I was approved today and there were NO issues. Submitted to Tricare on 10/6 and got approval 10/09

[KarinaM 0]

Karina............... do they tell you why you were denied?

Yes and no they only sent me a letter saying I did not meet the criteria (the 100lb over with one comorbidity or 200%).

I "gained" 20lb more and sent my appeal. I'm sure it will be a denial because it's taking more then 30 days.If it was an approval I think they would done it faster, What do you think?