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Help Writing an Appeal Letter



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I need help writing an appeal letter to Tricare;

When my information was first submitted; I weighed 219.5 and am 5'6". It was denied.

My doctor resubmitted my information on my frame size which is small and my new weight of 228.5; I gained weight after having surgery on my leg and being off for 6 months.

Anyway, I am now according to Tricare over 100 pounds and I have HBP, diabetes, infertility, hight cholesterol, arthritis, acid reflux.

Where do I start? What do I say? If you have any examples you can send them to delta27@earthlink.net or attach them to an email on here to me.

Thanks

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I need help writing an appeal letter to Tricare;

When my information was first submitted; I weighed 219.5 and am 5'6". It was denied.

My doctor resubmitted my information on my frame size which is small and my new weight of 228.5; I gained weight after having surgery on my leg and being off for 6 months.

Anyway, I am now according to Tricare over 100 pounds and I have HBP, diabetes, infertility, hight cholesterol, arthritis, acid reflux.

Where do I start? What do I say? If you have any examples you can send them to delta27@earthlink.net or attach them to an email on here to me.

Thanks

I would be interested in answers to this as well. My insurance turned me down stating that it was a true contract exclusion... but in the letter they stated that our policy doesnt' cover stomach stapling or bypass... the band is NEITHER... so.. instead of dealing w/them for months on an appeal, I didn't want to wait..I was at 358.5 lbs 2 wks before my surgery w/HPB, high cholesterol, type 2 diabetes and a degenerative issue w/one of my knee and they said no.... so I took the money from my 401K and was a self pay... now I am planning on sending an appeal to try to get them to reimburse me... which will be less then if they originally paid for it as my surgeon gave me a good break on his fee... I have my pre-op and consult notes from my surgeon along w/the pulmonary and cardiac evals as well as copies of my blood work from before my surgery and this month, which was about 4 1/2 months post-op... my cholesterol has gone from 238 10 days before my surgery to 177... so any help would be greatly appreciated...

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Delta, I've sent you copies of my letters.

untflutter, if you would like a copy too, just send me your email address.

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Delta, I've sent you copies of my letters.

untflutter, if you would like a copy too, just send me your email address.

Suzanne.. that's awesome.. my email is untfluter@comcast.net

Thanks!!

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
    • KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
      · 0 replies
      1. This update has no replies.
    • bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
      · 0 replies
      1. This update has no replies.
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