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Tricare Denial..REVERSED!!

I just got the phone call from my surgeon's office. Tricare has now

APPROVED ME!!!

Surgery is Sept 30th

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HelloPenny is being banded now. Yay for her. TomatoGirl, I'm right behind you on the banding. I had my preop test today. They did a pregnancy test and I had to laugh. I'm 54 years old and have had a complete hyster. (sorry don't know How to spell it).. So I told them to make sure they call me if I'm pregnant:lol:. Have a good day. Maggies:shades_smile:

Meggie, you made me:lol:. You are funny. I'm so happy for you guys. HelloPenny is probably done by now,I guess. Are you ready for your surgery? How about you Tomatogirl? Are you both on the LapBand? I'm hoping they approve me for my gastric Bypass. Nothing yet but if I'm sure if I think hard I will realize they are just taking their time to tell me NO!!!!!. Oh well....

somewhere on the tricare website there is a place that you can look at where your claim is as far as processed or approved or pending. The person at the doctors office should have told you about this place. Have them check into it. Good Luck

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The thing about the website is that it is about 48 hours or more behind. For those of us that are OCD, well, it drives up bonkers waiting!!

Karina, Are you going to have the Gastric Bypass or Lapband? Is your husband active duty? I could have had the gastric bypass at Travis AFB, without going thru Tricare. Why don't you call some military hospitals and see what it would take to have it done at one of them. It would be another option for you if Tricare denies you again.

Darn, I am not pregnant, o well maybe next time. I was ready to call the Guiness Book of World Records.

Yep, HelloPenny is probably banded by now and on the losers bench.

Maggies:shades_smile:

Karina, Are you going to have the Gastric Bypass or Lapband? Is your husband active duty? I could have had the gastric bypass at Travis AFB, without going thru Tricare. Why don't you call some military hospitals and see what it would take to have it done at one of them. It would be another option for you if Tricare denies you again.

Darn, I am not pregnant, o well maybe next time. I was ready to call the Guiness Book of World Records.

Yep, HelloPenny is probably banded by now and on the losers bench.

Maggies:shades_smile:

Meggie, I'm trying to get the gastric bypass, I want to go EXTREME. Do you think I could go to Travis? I have Tricare Prome Remote, so I think I'm not allowed to go to a military facility. Do you think they would be easier there? Do you think if I get denied now for the gastric can I ask the doctors office to resubmit as a LapBand (would this be a new authorization or they would take my old one?

Meggie, I'm trying to get the gastric bypass, I want to go EXTREME. Do you think I could go to Travis? I have Tricare Prome Remote, so I think I'm not allowed to go to a military facility. Do you think they would be easier there? Do you think if I get denied now for the gastric can I ask the doctors office to resubmit as a LapBand (would this be a new authorization or they would take my old one?

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.:grouphug:

Karina, I don't know anything about Tricare Remote, but from what Tomatogirl said you can do it. All you will need is a letter from your doctor referring you for the gastric bypass. That is all Travis does. That is why I am going to an off base doctor because I decided I wanted the lapband. I see your from Mountain View, where is that located?? If Tricare denies you this time it sounds like you have other options. It will just take time and work. It was Sept. 07 that I first got my referral letter to Travis for gastric bypass. But then of course I changed my mind so had to start over with everything for the lapband. But a lot of the tests are the same so that was one good thing. Well good luck and keep trying.

Maggie:shades_smile:

Karina, I don't know anything about Tricare Remote, but from what Tomatogirl said you can do it. All you will need is a letter from your doctor referring you for the gastric bypass. That is all Travis does. That is why I am going to an off base doctor because I decided I wanted the lapband. I see your from Mountain View, where is that located?? If Tricare denies you this time it sounds like you have other options. It will just take time and work. It was Sept. 07 that I first got my referral letter to Travis for gastric bypass. But then of course I changed my mind so had to start over with everything for the lapband. But a lot of the tests are the same so that was one good thing. Well good luck and keep trying.

Maggie:shades_smile:

Meggie and Tomatogirl you guys gave HOPE again. I called Travis AFB and they told me all I need is a letter form my PCM. I called my PCM and she is off today but I asked her to call me tomorrow. They told me it takes abt a week to be added to the sytem and then they will call me for an appt. By this time it will be Nov 8th(last day for Triwest to give me an answer). I will take ALL my paperwork and hopefully will work, lets see. I really don't care WHERE I wil get the surgery, of course I would love to get it with my gorgeous doctor Sanchez in Burlingame, but as long as I get it done.

My first choice was the band because I was going to get it with Dr. Ortiz in TJ, but since money was very short and I realized I had a chance to get approved I decided to try.

Meggie, Mountain View is between Palo Alto and San Jose, it is in the Sylicon Valley (Google HQ is located here). It's abt 30mi from San Francisco. My husband is works at the USCG San Francisco Air Station (SF airport).

Thank you one more time Tomatogirl and Meggie. Of course I can NEVER thank my friend JWRN enought. If I get approved by TriWest will be totally her fault. hehehehe

  • Author

Glad you are doing good! We missed ya :eek:

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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