Tricare Reserve select

javoanta2
on 3/28/12 10:47 pm
 My Doctor sent ina request for revision surgery which was denied due to not meeting requirements. I'm 5'2' and weigh 185 which puts my bmi at 33.8 but Tricare says it has to be 35.I have highbood pressure and im taking too pills,and I take byetta shots twice a day along with metformin 4 pills a day. They said I can appeal because they say my bmi is 31.89...UGGGG!!!!Help please
(deactivated member)
on 4/1/12 7:37 am - Mexico
On March 29, 2012 at 5:47 AM Pacific Time, javoanta2 wrote:
 My Doctor sent ina request for revision surgery which was denied due to not meeting requirements. I'm 5'2' and weigh 185 which puts my bmi at 33.8 but Tricare says it has to be 35.I have highbood pressure and im taking too pills,and I take byetta shots twice a day along with metformin 4 pills a day. They said I can appeal because they say my bmi is 31.89...UGGGG!!!!Help please
 
Sadly, they do have the right to deny you, you don't meet their requirements.  You can try to appeal and your FINAL appeal would be a peer to peer.  Don't do it without exhausting your other appeals because they will deny you if you go right to the ins co medical director without going through their stupid process.

Or, self pay.

Usually ins co's require a BMI of 40 without comorbids but with comorbids they will accept a BMI of 35.


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