TRICARE Coverage Problems :/
Bad day. I wasnt denied but I was given a pretty dificult request. So pretty much tricare told my pcm that I need documentation of failed diets in the past! PLEASE help me! Why would I keep documentation of diets I have tried and failed at? I guess my best bet is calling jenny craig, weigh****chers and medifast and asking for bills? I have no clue but I am very discouraged today. I am 5'1 weigh 258 and have a bmi of 49. I have high insolin levels and high theyriod, those are my only problems. For me I would think the weight and BMI would do it for me :((.
Not unheard of. My insurance co required proof of failed attempts within the past 2 years - had to be either 6 consecutive months of physician-supervised weight loss and/or 2 attempts at 3 month programs (WW, Jenny Craig, etc). Mercifully I'm anal-retentive enough to always keep any health-related receipts & results. They took receipts of when I did WW online, lab results from a medical weight loss clinic and a monthly diet log signed by my PCP.
First ultra: Stone Mill 50 miler 11/15/14 13:44:38, First Full Marathon: Marine Corps 10/27/13 4:57:11, Half Marathon PR 2:04:43 at Shamrock VA Beach Half-Marathon, 12/2/12 First Half-Marathon 2:32:47, 5K PR Run Under the Lights 5K 27:23 on 11/23/13, 10K PR 52:53 Pike's Peek 10K 4/21/13, (1st timed run) Accumen 8K 51:09 10/14/12.
Hi Bellaafwifey! What a bumber. I have Tricare Standard and are close to have my info sent in for approval. Did Tricare have you do a six month supv weight loss diet? Do you have Tricare Standard or Tricare Prime. I am sorry for your situation. Hopefully you can get this all worked out and be on your way to a healtlhier you! Please respond. FoxyMomMa
Oh girrrrrrrrl. Don't get me started on Tricare.
They had me in tears quite a few times throughout this long, convoluted process. They keep switching up their requirements and losing documentation and changing their story... it's ridiculous. BUT, I did just manage to get approval last week, and my nurse practitioner has a good relationship with the bariatric department over there, and she gossips to me, LoL, so I kinda know what's going on with them, so let me share.
Apparently, Tricare is changing their requirements because they've had quite a load of bypass requests over the last year. Understandable, kind of. BUT, they also decided that this was a really great time to let go of the lady who usually handles bariatric patients, and hire a new woman who is kind of a mess.
So. Same thing happened to me, sister. After almost a YEAR of going through every test imaginable and resubmitting a ton of paperwork, they officially denied me because I didn't have a documented weight loss program, or proof of failed diets.
So I decided to suck it up and play their game. I went back to my PCM and told him I apparently needed to do a supervised weight loss program and asked to get started. He had no idea what I was talking about, had never heard of needing that from Tricare (admittedly, my PCM isn't the sharpest tool in the shed), so he went upstairs from the clinic and put in a referral with Tricare. Basically, he put in a personal referral, stating that I have tried to lose weight in the past and failed, and that he recommends me for bariatric surgery.
My surgeon resubmitted my request with my PCM's referral attached, and I was approved 4 days later. This just happened last week. My nurse practitioner called to give me the good news, and I got my surgery scheduled that day.
I know it's heartbreaking, and a truly tedious, awful process with them nowadays. Stick with it, see your PCM and see what he can do, and stay the course. Don't give up!!
They had me in tears quite a few times throughout this long, convoluted process. They keep switching up their requirements and losing documentation and changing their story... it's ridiculous. BUT, I did just manage to get approval last week, and my nurse practitioner has a good relationship with the bariatric department over there, and she gossips to me, LoL, so I kinda know what's going on with them, so let me share.
Apparently, Tricare is changing their requirements because they've had quite a load of bypass requests over the last year. Understandable, kind of. BUT, they also decided that this was a really great time to let go of the lady who usually handles bariatric patients, and hire a new woman who is kind of a mess.
So. Same thing happened to me, sister. After almost a YEAR of going through every test imaginable and resubmitting a ton of paperwork, they officially denied me because I didn't have a documented weight loss program, or proof of failed diets.
So I decided to suck it up and play their game. I went back to my PCM and told him I apparently needed to do a supervised weight loss program and asked to get started. He had no idea what I was talking about, had never heard of needing that from Tricare (admittedly, my PCM isn't the sharpest tool in the shed), so he went upstairs from the clinic and put in a referral with Tricare. Basically, he put in a personal referral, stating that I have tried to lose weight in the past and failed, and that he recommends me for bariatric surgery.
My surgeon resubmitted my request with my PCM's referral attached, and I was approved 4 days later. This just happened last week. My nurse practitioner called to give me the good news, and I got my surgery scheduled that day.
I know it's heartbreaking, and a truly tedious, awful process with them nowadays. Stick with it, see your PCM and see what he can do, and stay the course. Don't give up!!
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Check out my video blog! www.youtube.com/user/HappilyShrinking/videos
Highest weight: 269. Surgery weight: 233. Goal weight: 144, and then we'll see..
Check out my video blog! www.youtube.com/user/HappilyShrinking/videos
Highest weight: 269. Surgery weight: 233. Goal weight: 144, and then we'll see..
I totally misread your post. I'm sorry, I thought you said you HAD been denied. So...ignore my totally over-answering response. 
Yeah, since you've actually done organized weight loss programs (which I hadn't, I just yo'yo'd on my own for years), it shouldn't be a problem for them to fax you your records and for you to send them on to Tricare.
Best of luck!
Yeah, since you've actually done organized weight loss programs (which I hadn't, I just yo'yo'd on my own for years), it shouldn't be a problem for them to fax you your records and for you to send them on to Tricare.
Best of luck!
I got approved with tricare standard first try. My surgeons office sent records from my pcp documenting my weight for 5 years, weight loss plans I had done including for how long and how much lost. Even though you lost on the diets, you regained and it still is considered a failure.
HW 240 SW 224 CW 167
I just got approved on tricare prime south and only had to have my pcm's referral - strange how they are different in different regions. When I started this process there was no requirement for the documentationa on the tricare website - they recently added that - good luck to you -I would call tricare and speak directly to a patient rep and ask the what the policy actually is and if you started the process before the policychnge you can be grandfathered in -
If you are neutral in situations of injustice you have chosen the side of the oppressor ~ Desmond Tutu 
My PCM did refer me but he is new. He said he is fighting for me though. I guess the fact I wasnt denied is a possitive. I hope the fax from medifast is all I need, I am totally scared I am going to be fighting this for a while, but I am prefpared to fight. I heard trisouth is easy to get approved and triwest sucks, so lucky me. lol I am tricare prime.
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