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Tricare Denial..REVERSED!!



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Wow girl, I would love to be 178. I have a long way to go to get there. I seem to be losing terribly slow, but as long as it is going down, thats OK with me. I seem to have restriction because I get full on just a little amount of food. Well, have a good one. Maggie:shades_smile:

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Thanks for the advice! I have my appt with the dr. on wednesday and I know he will order the sleep test. No I am not on blood pressure meds my quack PCM ( which I do not see anymore ) told me it was fine and not to worry. I'm glad to hear you are both doing well and I will post after I see the dr on Wednesday.

Thanks

Ashley

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Good luck to you on Wednesday. Boy do I remember how it feels to go thru all the steps you are going thru now. It is worth it so keep on moving towards your goal. Maggie:shades_smile:

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Hi Maggies and JWRN-

I saw the dr yesterday he seems very positive that I shouldn't have a problem getting approved ( Im guessing lots of people have been told this aswell ) but apparently my blood pressure was high again and he claims if you have more than one reading aleast a week apart that are high then you have Hypertension which is covered by tricare. I just have to get copies of the readings even though I am not on medication for it. I'm trying not to get my hopes up does this sound right or is it too good to be true. Anyway thanks for your advice.

Ashley

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Ashley, Sounds like you have what you need to get approved. Hopefully by the first of the new year you should be banded. Let us know. Maggies:shades_smile:

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Hi, I hope you do get approved without having to jump through too many hoops. I would make sure that the Dr - writes everything down. I had high blood pressure - but was not taking meds. So they said it was untreated and I believe that was what got me denied the first time. I had my BP and my weight monitored for a week. I MADE the Dr give me a HP pills and I have resubmitted my letter. I have been waiting for ove 60 days on this second appeal. The first one I got back in less than a week. I believe the more they know about you the first time the easier it will be. Make sure if there is anything wrong with you it is in your records and writen in the letter that they submit to Tricare. Good luck and I will pray for you.

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Well, I have been at a plateau for the past couple of weeks. Thanksgiving I was grazing all day and really didn't feel much restriction. I didn't eat any dessert except for one choc chip cookie that my youngest daughter made. I was for sure that I had pigged out and gained weight. I just haven't had the restriction and was eating more than I had since my surgery. Well, I think this helped up my metabolism! I have lost 4 more pounds this weekend!

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JWRN, You are doiing great. My weight loss is going very slow but at least it is not going up. I have an appt. with the surgeon this coming Friday so I hope he isn't upset by how little I have lost. Have a good one. Maggie:shades_smile:

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The only good thing about not being banded yet is I did enjoy more than a cookie! I am actually trying not to diet just incase they want me to jump on a scale agian. This is the first time in 10 years I have not been on a diet.

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How did you do it? I am fighting with Tricare now and they keep telling me I have to wait another 6 months to apply again. I have done everything under the sun and still they deny me. Could you get into more detail on what the turn around on Tricare's part was? Let me know. Thanks.

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Hi Valerie, Have you been denied by Tricare Already or are you just starting the process. I was denied by Tricare the first time and then we resubmitted the paperwork to include my sleep apnea test and I was approved in 2 weeks. There is another girl on this thread that was denied and appealed and Tricare took several months and ultimately she was denied. Let us know how it is going for you. Maggies:shades_smile:

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I am going crazy trying to second guess TriWest. I had no problem getting a referral and seeing a Dr. I had my Dr do a weigh-in, went to a seminar and then they submitted the paper work thinking everything was fine. It was denied. TriWest Phoenix sent me the denial letter and I submitted what I thought was enough info. - but silly me I did not enclude my medical records, only a letter like I thought they had asked for. So they denied me again. I will take the hit for that one. I had all the number correct, I simply thought that they had access to my records. They do not. So with the second letter I encluded everything! I went to the clinic on post and weighed in everyday and had my blood pressure monitored. I renewed all my perscriptions so they knew I was taking meds for high blood pressure, high cholesteral and low thyroid. I had an old English teacher edit my paperwork and make sure that there was no mistaking what I had or what I wanted. I sent the package off certified mail - because they do not have a fax number in Aurora Colo. They recieved the package 2 days later. They responded to me 2 WEEKS later with a form letter simply stating that they had it. I have now been waiting sense Sept 25th with no end in sight. I was told - not once - not twice but three times that they have no time limit on when to respond to my appeal!!! So I will worn anyone that is trying to work with Tricare - make sure everything is right the first time or they will make you wait and wait and wait and ..... 60+ days and still waiting!!!

I wish you luck. I have a friend in GA that went through this she had almost the same with (3 pounds less than me). Only high blood pressure and she was approved in 2 weeks. So I believe that it is luck of the draw and not regulation that guides TriWest.

Hope you get what you want - I am still waiting.

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I'm so excited after 6 months of fighting with tricare , I finally won !!!2 appeals and a formal appeal to tma. It really pays to fight for what you want .:thumbup: surgery in Febuary!!!

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I'm so excited after 6 months of fighting with tricare , I finally won !!!2 appeals and a formal appeal to tma. It really pays to fight for what you want .:thumbs_up: surgery in Febuary!!!

Ok so I am very jealous!!! I am still fighting with them I re-sent everything - after they lost i t or what ever. So now they say I have to wait until at least Jan. 26th. I hope pestering them helps - be cause I have been!!!

Good luck and keep us posted. I hope to find out soon. I keep thinking of all the winter clothes that will be on sale soon - I can buy them on closeout!!!

Again - I am really happy for you!

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I'm so excited after 6 months of fighting with tricare , I finally won !!!2 appeals and a formal appeal to tma. It really pays to fight for what you want .:) surgery in Febuary!!!

Ok, I have to know. What do you weigh, what was you co-morbity? Why did you get denied the first 2 times? What did you put in you letter for you final appeal? I am going crazy! I am 100 pounds overweight, Ihave high bolld pressure, low thyroid and degenrative discs in my lower back. I keep getting the run around from TriCare. I had to appeal and wrote my letter sent it to a lady named Bridge Ewings - who seems to be very disorganized and I am not sure what she is doing with my info. She told me at the begining of December that I should have an answer by Dec 13, That day came and went. Now she says that "maybe" I will know something by the end of January!!! I went through Dr. Monash and he did absolutly nothing for my appeals - he would not even call Tricare and see why I was denied - I had to guess! So yes I will take any extra help I can get.

Again - Wow you are soooooo lucky. I wish I would get a letter soon saying I was approved.

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