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Tricare Denial..REVERSED!!



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Why did you get denied the first time? Was the appeal any different than the original request?

I checked mine wayyyy too often online:)

Best of luck!!

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I got the denial reversed last week and I STILL check the tricare website!! I think I need another PSY eval!!

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Karina, Good for you, hope you get your approval soon. It is worth fighting for. Maggie:wink_smile:

Thank you my friend. How is your journey? Did you get approved yet?

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Not yet, I have everything done, just waiting for the surgeon to send the info to Tricare. They are taking to long to do it. I have worked so hard for this and did everything they ask me to do. And now they are dragging their feet. Good luck again on a quick approval for you. Maggie:shades_smile:

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:)

Thats wonderful!!!

I went to my pmc today and he put my referral in!(fingers crossed)

I have heard they can make it very hard to have done!!

Any advice as to what steps to takeif they deny me?

:mellow:

thanksVenus

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Not yet, I have everything done, just waiting for the surgeon to send the info to Tricare. They are taking to long to do it. I have worked so hard for this and did everything they ask me to do. And now they are dragging their feet. Good luck again on a quick approval for you. Maggie:shades_smile:

Hi Meggie, any news? I'm still pending.

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I think I saw somewhere today that she got denied:cry_smile:

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Ya, I got denied, I don't think I am going to appeal it, Because I am over 100lbs. overweight and I have 2 of the required comorities(sp). So I don't know what I could do different. I am really bummed. I wish you all luck and successfull banding.:smile: Maggie

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awww...maggie.

I'm in the same boat. i am 260, 5'6. I have sleep apnea, and I'm on the CPAP. I got denied.

I think maybe my doc's office didn't include all my sleep test stuff, maybe.

I think it's my doc.

Don't give up. Lots and lots of people get approved after a denial.

You can call, and they will give you a reason for the denial, even though the reason isn't in your letter.

THey told me that depression was my only comorbidity, and it doesn't count....so they just didn't get my sleep apnea info...

Keep trying, I am!

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Ya, I got denied, I don't think I am going to appeal it, Because I am over 100lbs. overweight and I have 2 of the required comorities(sp). So I don't know what I could do different. I am really bummed. I wish you all luck and successfull banding.:confused: Maggie

You've got to be kidding/ OF COURSE you have to appeal. Did they tell you WHY you got denied? I understand I got denied because I have no comorb (I'm prediabetic and high cholesterol, but they do not consider) and I was under the 100lb before so I had to "gain the extra pounds, but you should DEFINETLY appeal.Let me know if you need help. JWRN helped me a lot maybe I can try to help you on your appeal.:wub:

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Maggie,

You HAVE to appeal. A lot of times it is because the doc's office did not send everything in. When you denial letter comes in, see exactly what it says...then appeal.

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:regular_smile:Thanks to you all for your support.:thumbup: I haven't received my denial letter yet, but did talk to the surgeons office. It said that the surgeon could call them and talk about my case. Has anybody heard of this? He is going to call Tricare next week. I don't put to much hope in this, but we will see. Any news on your appeal Karina? Maggie:shades_smile:

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:regular_smile:Thanks to you all for your support.:thumbup: I haven't received my denial letter yet, but did talk to the surgeons office. It said that the surgeon could call them and talk about my case. Has anybody heard of this? He is going to call Tricare next week. I don't put to much hope in this, but we will see. Any news on your appeal Karina? Maggie:shades_smile:

HI Meggie. I never heard of the surgeon calling Tricare but I think this is great. I could never expect this from my surgeons office. I emailed my surgeon coord asking her to call to find out what the status is and she never got back to me, not even to say no.

YOU HAVE TO APPEAL. Of course I had no answer on my appeal. I call TriWest abt twice a day, but I know will de a Denial. I really think YOU have great chances to win on your appeal, so don't give up.

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I will say, from what I've read, Tricare is VERY rigid. If, per their tables, (and they use something odd like the low end of the met life tables from 1980 or some such nonsense...you need to find out exactly WHAT...) you are supposed to be 100 pounds overweight and are only 99 overweight, they DENY you. This goes against common sense, but it's what they do. Too many people get a defeatist attitude and let them get away with it. If you want the band badly enough, find out exactly WHAT they are missing and make sure they have it! What will it take you, a few hours? and save you what, 15K or so? I don't know about you but I don't have a job that pays me 15K for 5 hours of work. Don't let them do this to you!

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