TRICARE Denial

Just wondering if this has happened to anyone else.

I was denied surgery because of a half a pound (for the 200% over ideal body weight).  We appealed and lost the appeal.  I have now gained the weight to be over the 200% and went to the surgeon who weighed me and put it on my medical records.  They also submitted a new request for surgory based on the new weight.  Just hoping it works, wondering if any of you have heard of this. 

I am getting frustrated....

Good luck to you.  I have no experience with Tricare, but I think it is just ridiculous for them to require you to be 200% over IBW.  That is just asking for people to go out and gain additional weight.

And really, how does that benefit anyone???

I would be frustrated too.

Julie

I know it sucks. I am less than 200 pounds over my ideal weight, for less than 200 pounds you "have" to have a secondary condition. My PCP put PCOS as my secondary condition, we were surprised they approved it. They don't waiver, I hope with your new weight submitted it gets approved. It only takes a couple of days for them. I know from working with them for my IVF they wouldn't budge with me over the BMI you must have to qualify, so we had to pay out of pocket for everything,

 My GP at Ft. Lewis told me it was 100lbs overweight and they would refer me to the program.   It took a seeing a few different people before I actually got the referral.  Some doctors had their own opinion about WLS and didn't support it, instead of listening to what I wanted or needed.  Finally, a female doctor gave me the referral and I started the program.  Almost 10 months later and I'm down 138lbs.  

Keep trying!! You just need ONE doctor to say yes to refer you to the program.  

GOOD LUCK! 

Forms were resubmitted today.... I hope to hear back by Friday!!!  Keep your fingers crossed that I am approved now, I am sick of hurting.....