Have you seen a dietician at all?  For the 3 month md program we were required to see a registered dietician. That has to be documented in the office visit notes of your physician that you have seen the dietician.  Three of us did the 3 mo MD program and my one son did the 6 month route. 

Good Luck, sounds like you are very close to getting approve!

Hi,

My out of pocket was approximately $1,800.  We have a specific percentage of out the of pocket cap.  So for example, my out of pocket caps out at 3% out my base salary.  So last year when all three of my kids had WLS  in the same year, I paid the $1880 out of pocket on my daughter.  Then when it was my son's surgeries in Dec, since I had already met my maximum out of pocket, I only had to pay each of their $500 deductible and the rest was covered. 

You probrably have a deductible, then a maximum out of pocket you have to pay. 

All four of us (myself and my three kids) were approved by Aetna.  for my sons, they were approved within 2 weeks.  For myself and my daughter, we were denied at first, I filed appeals, and then it took about 30 days from the time they received the appeal to get the approval.

Are you doing the 3 month multidisciplinary program or the 6 month supervised diet?

Good Luck to you!

Nan

 

 

I found this on Military Times Tricare Help Blog.  Hope it helps.

Why does my doctor keep billing me?

JANUARY 25TH, 2010 | TRICARE HELP | POSTED BY MILITARY TIMES

   

Q. My doctor charged $268. Tricare allowed $192.50 and sent me a check for 75 percent, or $144.38. I paid the doctor $192.50 plus the 15 percent surcharge, for a total of $221.38. Now the doctor is demanding another $46.62, making the total the amount of his original bill, and says he’ll turn my account over to a collection agency if I don’t pay. It’s my understanding that federal law doesn’t allow him to do that. What should I do?

You are correct. The doctor may not charge you more than 15 percent over the amount Tricare allowed. If he sees Medicare patients, he is aware that the Limiting Charge law applies to Medicare claims; he needs to learn that it applies to Tricare claims also.

You should send a report to the Tricare office that processed your claim. The address is on the Tricare Explanation of Benefits form. Include a copy of the EOB and any “balance due" notices from the doctor. If the doctor persists, report him again.

It is unfortunate that the law will not allow Tricare to do more than write to the doctor and explain the federal law. Beyond that, all it can do is threaten to discontinue his status as a Tricare-authorized provider and threaten to cancel his ability to participate in other federal programs such as Medicare.

The doctor may be unaware of what his billing clerk is doing. You might consider writing or talking with him about it.

thanks for getting back with me, so far, i am getting the psy evaluation done on base, so there is no co pay or anything like that. the nut counseling is what my surgeons office requires and tri care does not pay for that so that is going to be out of pocket, i am going to my cardio and EKG tomorrow afternoon, my psy eval is next thursday...

so things are moving quickly, i will just be out of pocket the $600 but that is not too bad compared to be self pay,

thanks and keep in touch there does not seem like there are too many military on this board.
have a great day
debby

There are a few people that have appeal letters on their page. If you haven't already post this on the VSG forum to see if someone can help you. I know of a few people that have appeal letters.
Also, google WLS appeal letters, there are few that come up.

I am actually about to post on the VSG forum to ask if any one had any appeal letter statistics on performing surgery on people with a BMI under 50.

Hope this helps.