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Tricare Denial..REVERSED!!



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Are you guys ready to hear my wining??? Here I go:

Yesterday I wrote an email to the appeal people asking them to take me out of my misery and how stupid I think this wait is etc.

This is what I got from them:

Dear KARINA,

Thank you for your recent web mail inquiry.

According to the notes on your file, the appeal process will be completed by 11/8/08. You will receDear KARINA MANG,

Thank you for your recent web mail inquiry.

According to the notes on your file, the appeal process will be completed by 11/8/08. You will receive the determination via mail. We do not have any way of "speeding" up the process, these guidelines are set forth by the DoD, Peer Review and the Medical Director.

If you require additional assistance with this issue, please call TriWest toll free at (874-9378).

When I made my midday call this morning guess WHO answer the call the same IDIOT who answer my email. Of course we got in to it and he try to tell me my appeal is a FACTUAL not a MEDICAL NECESSITY appeal (he pretty much is telling me I just WANT the surgery, I do not need it).

I just can't take these people anymore. I wish I could complaint to someone higher then a CUstomer Service Rep.:smile:

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I am so sorry to hear that!!! Belive this or not, I had no problems at all with getting my approval from Tricare......it was the docs office that wasted 2 months of my time. After I recieved approval (which only took a week) the doc told me I would have to pay his office $4000.00. I am starting all over now.

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I am so sorry to hear that!!! Belive this or not, I had no problems at all with getting my approval from Tricare......it was the docs office that wasted 2 months of my time. After I recieved approval (which only took a week) the doc told me I would have to pay his office $4000.00. I am starting all over now.

I'm so sorry you had to start over. I also had the same problem to get approved. My doctor's office took 2 weeks to fax extra info to TriWest so while the authorization process should not take more then 5 days it took 12days. (MY LUCK)

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Wow Karina, they have you going around in circles. It looks like yours is going to the top for approval/denial. You have the 100lbs. to lose how about the one health issue? whey you called Travis, did you talk to A Mrs. Frazier. She is the go-between for bariatric patients and the surgeons. I'm sure she would be very helpful to you. Well keep on trying you will get it sooner or later. Maggies:shades_smile:

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I need to update my weight loss ticker. Can someone help me, I've tried to and it doesn't work.:smile: Help Maggies:shades_smile:

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I feel pretty good overall. There is some pain in my chest where the port is. I have an on-board pain medicine pump called OnQ. It delivers a Novocaine like medicine that numbs the area. It will probably run out tomorrow and I have to remove it myself. Just a small plastic catheter. I think I will make my Mom do it. LoL.

I have been taking my liquid hydrocodone like clockwork. I am a little uncomfortable when sitting especially if I am in a slouching position. I feel much better when I stand or sit very straight up. Laying back in a recliner feels better. I have been sleeping in a recliner. I tried laying down on the couch the other day and didn't feel comfortable and then I couldn't sit up without help. So, I will skip the laying down for awhile.

Yesterday I had the pain in my neck/shoulders that they talk about. MY anesthesiologist said it was from air getting caught under the diaphragm and pushing up. I had previously heard it was from air roaming around in your chest and traveling to your shoulders. I think the anesthesiologist explanation sounds a little more believable.

I am hungry. I have been dreaming about food. Commercials are torture. I have gotten like 5 emails today from different companies/web-sites with recipes, and they all look so good. There was one with Soups and stews that really got to me. I kept making my Mother look over to show her a recipe that looked good, and she finally said "You are just hungry." Then she started ignoring me. We were driving home earlier this evening and passed a factory near our house that makes frozen Mexican food, Ruiz. I said "Oh, that smells so good!" and my Mother said "I can't even smell anything!"

So needless to say I am looking forward to Saturday when I get full liquids. I am disappointed that my Doctor's diet does not have eggs on it. Anyone else have eggs in theirs? When could you start having them?

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Penny, Any regrets yet? That may be a silly question to ask, but since mine is so close and I have heard so many people say the first week they have buyers remorse. Where exactly is your port located and can you feel it. I know each doctor puts them in different places. Feeling hungry I know is going to be a hard thing to deal with, but having the band will surely encorage us to eat right. We don't want to do damage to it or us. Did you make your first appt. for a fill yet? Hope you feel better each day. Maggie:shades_smile:

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The pain you will have in your chest area is your port, apparently.

I haven't been brave enough to really poke around my stomach to feel the port. Gingerly poking around, I don't feel it. So, I don't have some big hard lump that is obvious.

My Doctor's literature says no fills for 6 weeks, so no I don't have an appointment for a fill yet. I do have a follow up appointment.

I took my pain pump out this morning. Didn't hurt at all. Probably because the area was numb! A small scab had formed around one of the catheters. That hurt a little.

No regrets. I have not been in any pain that was over a 3 on a scale of 1 to 10. I have been taking my medicine religiously though. I think some people avoid taking it or feel compelled to not take it. Not me! Give me the drugs!

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You sound like you are really adjusting well to bandlife. You are brave if you took the pump out yourself. I couldn't do it, to big of a chicken. I don't mind shots and such if I don't look. Keep up the good work, walk, walk, walk.

Karina, any news yet. If you need Mrs. Frasiers direct number, let me know. You are going to be successful one way or the other. Maggies:shades_smile:

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Well, I wasn't going to do it at first. But, then when I pulled on it to see it just started coming out really easy and it didn't hurt at all. So I was like OK I can do this!

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After surgery, I had buyers remorse. In fact, as I was in the ER, I seriously considered clawing out the band myself. This passed after my nausea and pain got under control. Then I became very protective. When the infectious disease doc told me that I could lose my band, I was thinking "no way am I going through this again! I am keeping this baby!". I got hungry when I was on liquids. When I started full liquids it became better. Mushies even better. But I did not cheat. It wasn't worth it to me. This whole thing has been a mental process. If once you get on mushies and are hungry all of the time, talk to the surgeon. They may end up giving you a fill early.(At least my surgeon's office will...why make you suffer?)

Karina, take a deep breath and forget about it until your letter comes. I know this is easier said than done, but I had to get away from it while I waited for my answer. I stayed away from Lapband talk, I tried not to think about it 24/7. You will drive yourself crazy. You can look into other options in the mean time. Perhaps they are having a panel review it and not meeting until that day. Hugs to you.!

Edited by JWRN

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JWRN, Wow, I'm excited, and yes a little nervousness has creeped in. You are doing great after your rough start. Mine should be an outpatient surgery. I am leaving for my sons house early Tuesday morning because I have a preop appt. with the surgeon that day. Don't know if I will coming home Wed. or Thursday. It is a 2 1/2 hour trip each way. My daughter is driving me. Do you think I could make the trip home after the surgery? I was thinking that I will still be under the influence of drugs from the surgery and it might be better than the day after. Everybody let me know your opinions. Maggie:shades_smile:

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I was glad to stay in the hospital over night. I was on a Morphine PCA pump and IV antibiotics. It was nice to be there "just in case". If you have a choice (I think Tricare requires you to spend the night) spend the night.

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The surgeon told me it will be an outpatient procedure, so hopefully I won't be staying overnite. I have had 4 surgeries in the past year and am sick of hospitals. I hope I feel like going home, but you never know till its over. Have a good weekend. Maggie:shades_smile:

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