Hit my first bump .. totally confused. PLEASE HELP

Well seems joyce says that I have been declined surgery. though I called tricare and they said that it was never put in for approval cause they never recieved anything. So how do I appeal a denial that hey say they never gave me??? In the handbook it says that to be approved you ahve to be 100 pounds over with commorbidities or 200% over your ideal with no comorbidities. Granted I have never been great at math but I can figure that out. I don't know what else to do. So considering it looks as if I am not going to get to have my sugery next monday. me picking the place for dinner would be silly. Anyone that has ANY ideas as to what I can do PLEASE PLEASE help. I have tried talking to tricare and they REALLY want to help, but as they say they haven't even recieved the paperwork from the surgeon's office so till they do there is nothing they can do. Yet Joyce is telling me that I am already denied.

Dr. Byrne has an assistant named Amanda who helped me get the right paperwork to CIGNA. She is supposed to be overseeing the surgery department. I will see if I can find her name and number at work tomorrow and send it to you. Other option is to tell them to give you what they submitted to TriCare and then submit it yourself..... I know you are frustrated, but keep on pushing! Susann

Okay, I should have done this first, but I went on the MUSC site and I am pretty sure it is Amanda Graham @ 792-7172. Tell her your story and see if she can't help. Hope this helps. Susann

THanks she is out sick today but I left a message for he rto call me tomorrow morning. Hopefuly she can help me out. And I asked joyce for what she submitted to Tricare so I can have the documentaion and she stumbled abit and said she would have to get back to me on that. I could soo use a drink after all this LOL

Oh my gosh, Kylee, what a mess! I'd definitely call Amanda tomorrow and ask for her help- it sounds like their office messed up sending your stuff to Tricare to me! Dont let go of it, either, stay on top of it until you get approved! I'd have them pencil you in a date, too, and not wait till you get the official approval to get a date! Good luck, we'll be crossing our fingers for you!!! Rebecca

I have a couple of ideas. Call Tricare and ask them to do a conferance call to MUSC or go to the Tricare office on base and ask them. I have Tricare prime and as I said it took me about 6 weeks once everything is said and done. Have you checked the internet? I never got a letter or anything from Tricare with my approval only by way of checking their website www.mytricare.com. I actually had the Tricare provider rep help me with mine I can get you her name and number tomorrow if you call me at work 266-4885. Ask Joyce to produce you the letter where they denied you, I don't think they have, she has to be mistaken. If you are going to just call Tricare make sure you have someone that knows what they are talking about, I have talked to 3 different people on the same issue and got 3 different answers. If you aren't satisfied ask for a supervisor. Also try your PCM and let them know how you are being jerked around. Good Luck, Brittain

I have been checking the status online though I have been looking on the HMHS website. That is one reason I tend to believe tricare that they never recieved anything cause there is no sign of it online. Nothing. She is telling me that I am being declined cause obesity isn't a good diagnosis for surgery and I don't have any comorbidities. My BMI is 50.3, I know others with lower bmi's that have been approved with out comorbidities so that just doesn't make sense to me. I will be showing up there in person to request not only the doccumentaion on the denial but the originaly paperwork that was submitted with the confirmation that she says that she has that is was recieved by tricare and when. I have no problem submitting it all myself. Though I just don't see why it has had to get this far. I am one of the most understanding people about when things go worng. Even if there was something that was just over looked, I would have been totoally kewl if they just said .. this is the deal.. somethigs didn't get done just right and we need to do this over... Iwould have been fine with it yes I may have been a tad irked but Iwould have gotten over it in no time flat. I just dont like feeling like I am being Lied to.

Sorry to hear about your denial. Do not give up! Call Tricare and Joyce everyday if you have too. Get to the bottom of it. I had no problem getting approve through Tricare. It will be a good idea to submitted the paper work yourself. Just don't give up.

Oh I'm not goin gto give up .. I just got the best information that is making me feel so muh better about my stance on this. I talked to someone that used to work for tricare south doing .referall Authorizations!!! Seems that authorizations are faxed in to a central number and then downloaded by the healthcare finders so there would definitely be a record if it was sent. And since tricare has no record ANYWHERE, they NEVER recieved it. Thus, I COULDN'T have been denied.

Kylee, Keep HOPE ALIVE!!! Not long ago Susann was having insurance woes (remember Susann??) and it seemed as though things would not move forward as they should have. Within a couple of weeks, things just turned around and now she is on the losing side! Things will work!! Don't be discouraged!!! I'll keep praying for you!! Hugs and such, Towana