Tricare Denial..REVERSED!!

[HelloPenny 0]

I thought I was going home, but Tricare made me stay. At least they blamed it on Tricare.

I didn't want to inconvenience my family any more than I had already. Plano is about an hour drive from Denison. My Father took off work to watch my Daughter and my Mother was able to work from her laptop and run into work for a little bit, since she works close to Plano. I didn't want anyone to have to drive back down the next day or have my Father take more time off. But, that is what happened.

It was OK though. Staying in the hospital wasn't all bad. They took good care of me and I got more drugs than if they would have sent me home. I got muscle relaxers and pain medicine. Which was nice. I would stay overnight if I had to do it again.

[Maggies 0]

5 days and counting. I'm enjoying moving around with no pain, because I know I will not be feeling this good in a few days. How are you feeling JWRN & Penny? Maggie:shades_smile:

[Maggies 0]

You can go to military facility while using remote- so long as you're willing to make the trip. When my husband was in Iraq in '02, I lived with my parents and had remote. Instead of using remote, I would just schedule my stuff at the Air Force base about an hour and a half away on my mom's off day and we would drive over, do my stuff, then go do other stuff.:thumbup:

Tomatogirl It just hit me that your surgery date is Oct. 29th. also. Are you going home the same day. We will compare notes later next week.

Maggie:shades_smile:

[tomatogirl 0]

Tomatogirl It just hit me that your surgery date is Oct. 29th. also. Are you going home the same day. We will compare notes later next week.

Maggie:shades_smile:

Yup! Only 3 days! I can't believe it! I'm supposed to go home the same day unless there is a problem. Yippee! I just got back from meeting my dad so my parents can take my son for a couple of weeks- now it's just me and the husband in the house, which is odd...and quiet.

[Maggies 0]

Karina, any news yet? Got my fingers crossed for you. Maggies

Tomatogirl, I am hopefully going home the same day also, at least that is the plan. I'm hungry!!!!!!!!! Maggies

[KarinaM 0]

Karina, any news yet? Got my fingers crossed for you. Maggies

Tomatogirl, I am hopefully going home the same day also, at least that is the plan. I'm hungry!!!!!!!!! Maggies

NOT APPROVED. I checked this morning and it was still showing pending but this afternoon it was showing NOT APPROVED.

Well at least I got an answer. I will try to see my chances on Travis , but I'm not sure if it will work or not.Do you know if they go thru Tricare?

[JamieNP 20]

Karina, I am so sorry. It is pretty crappy. Hopefully you will get your surgery on post. I know it must be a relief just to get the answer.

[Maggies 0]

Karina, I am so sorry. Do you know yet why you were denied again? I'm pretty sure Tricare has nothing to do with Travis or any military hospital. You need a BMI of over 40 and you should'nt have a problem. Call and talk to Mrs. Frazier in the General Surgery unit. That would be a good starting point for you. Let me know how it goes. Maggie:shades_smile:

[tomatogirl 0]

Booooooooooo, poor Karina. :biggrin: I don't think the military hospital goes through TriCare (I almost went to Walter Reed for my surgery, but decided not to when I was going to have to wait 2 months for an appt).

[KarinaM 0]

Karina, I am so sorry. Do you know yet why you were denied again? I'm pretty sure Tricare has nothing to do with Travis or any military hospital. You need a BMI of over 40 and you should'nt have a problem. Call and talk to Mrs. Frazier in the General Surgery unit. That would be a good starting point for you. Let me know how it goes. Maggie:shades_smile:

Tomatogirl and Meggie, GOOD LUCK TOMORROW. Let us know as soon as you guys can how you are feeling. So happy for you guys.

I should be getting my letter tomorrow, but I already knew it would be a NO since Meggie and JWRN got their approval so fast.

Well I went to my PCM and gave her a letter asking her to give me a letter of referral and pretty much telling her what I need her to say.

I was trying to fax all the paperwork to Travis but my fax did not work, I don't know why. I did write a letter (almost the same I wrote to Tricare) but I don't know if it will help me since my main problem is not have any comorbidity (diabetes or high blood preassure). I do have the family history and a very bad acid reflux desease getting worse with the weight gain. Since I have a rod and six screws in my leg I am trying to play the joint pain card. Do you guys think this will work???? DO they only take the BMI? If they go thru Tricare I don't think I should go thru the trouble.

Well, GOOD LUCK again Meggie and Tomatogirl.

[JamieNP 20]

Good luck tomorrow Girls! We will be thinking about you! Let us know as soon as you get out and are feeling like chatting.

Karina, I would think that they would use the "joint" issue and the possible GERD. Any aches and pains related to obesity need to be used. If you need anything, let me know. I am anxious to find out why exactly they denied you.

[KarinaM 0]

Good luck tomorrow Girls! We will be thinking about you! Let us know as soon as you get out and are feeling like chatting.

Karina, I would think that they would use the "joint" issue and the possible GERD. Any aches and pains related to obesity need to be used. If you need anything, let me know. I am anxious to find out why exactly they denied you.

I have no questions it will be the same, they think it is cosmetic, not a medical necessity and since I do not have a comorbidity they gave me a big NO.

[kmcoolone 0]

Hi,

I'm Kim and I just had my consultation yesterday. I am pretty sure that Tricare is going to deny me because the scale at the surgeon's office said that I am 10 pounds lighter than my pcm's scale and also said that I am only 39.0 BMI. I hope that my diabetes my allow them to consider me but who knows. Anyway, I figure if nothing else I will just have to go through the appeals process but from what I understand, that really sucks too. Anyway, good luck to those who are having surgery today and this week. Hopefully it won't take to long for me to get all the answers from Tricare.

Kim

[JamieNP 20]

Kim,

If you have diabetes, then Tricare will go by the 100 pounds overweight. They use the met life height/weight table and use the medium frame. They DO NOT use BMI. If you are 10 lbs under you should have no problem gaining the extra weight to qualify, esp now that winter is coming up and winter clothes weigh more. Here is the link for the met life chart Met life ideal height weight tables references

[tomatogirl 0]

I'm home! I feel pretty good, but that might be the vicodin talking. I had to end up spending the night because they had to repair a hernia while they were in there. I'm so glad to finally be home!