Question:
Anyone delt with Tricare Standard on an appeal?
I was just denied surgery by Tricare (Standard) I got my non-availablity without a problem, but they said no to the surgery. The letter stated that my sleep study showed that I have snoring problem, not apnea. My sleep study, which I have had 1 more since, clearly states that I have obstructional apnea, I stopped breathing with the cpap. I am 100# over, but my BMI is 37. My surgery was supposed to be on Monday June 3rd, but I guess that's not going to happen. Any advice would be greatly appreciated. Colleen [email protected] — Colleen R. (posted on May 29, 2002)
May 29, 2002
Why don't you switch to Tricare Prime? I used to have Tricare Standard and
my $460 dollar a year family premiums now with Tricare Prime are so MUCH
lower than what any 20% I'd be out with tricare standard, especially with
this surgery. Also, Tricare Prime is easier to get approved :-) Good
luck.
— Tina P.
May 29, 2002
Tricare is very strict about their conditions. You have to be at least
200% of your ideal body weight with no comorbidities or 100lbs over your
ideal body weight with one of I think five comorbidities. You will need to
check your manual or do a search on their website. They are named there.
They normally do not make acceptions. Tricare Prime has the same coverage
as standard, so that won't help you. But you will pay NOTHING with Prime
and you have all the deductibles and such with Standard. Good Luck!
— Virginia N.
May 29, 2002
Colleen, I see you are from Virginia Beach. I had my surgery at Portsmouth
Naval and they are superb!! In fact, Dr. Spencer was the first to perform
the gastric bypass laproscopically in the state of Virginia. He travels
worldwide to train other physicians in this procedure. You will have the
most excellent care! His whole team is fantastic, they always act excited
to see me and wow'ed by the results. They truly have a passion for their
work. And I cannot say enough about the after care. They do follow-up
appointments and bloodwork much more often than the civilian doctors. The
surgeons, bariatric case manager, nutritionist and their RN attend each
support group meeting. The nutritionist also has an open door for 1 1/2
hours before the meeting each month where we go for weigh ins, nutri advice
and more labs can be ordered if necessary. They really keep a close eye on
us. And another 'perk', I didn't have to pay a dime in costs. As you can
tell, I have been very pleased. If you have any other questions, I would
be more than happy to talk about it. Please email me at
[email protected]. If you want to stay with your surgeon, I hope
everything works out for you.
— Cheri M.
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