DENIED Tricare STINKS!

MustangLady
on 2/4/13 2:34 am - MA

I just got a call from my surgeons office and was told that Tricare denied my revision from band to RNY.  I m so upset and pissed off.  She told me that they received a long explanation and I should receive mine in the mail soon. I then asked her what was next and she acted like she didnt care.  I am going to call Insurance as soon as I can speak.  I am left wondering what is next.

~ CJ BradleyLapband Surgery 7/2007 with many complications. 2012 Seeking Revision to RNY. 2013 Revision denied. Trying to work with band.

    

poet_kelly
on 2/4/13 2:35 am - OH

There's  probably an appeals process, right?  Don't panic just yet.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

Oxford Comma Hag
on 2/4/13 2:39 am

There is an appeals process. I know you are upset, and I do understand why. Wait till you get your letter so you can see why it was denied, then you can plan your strategy.

In the meantime, hang in there!

I fight badgers with spoons.

National Suicide Prevention Lifeline: 800-273-8255

Suicidepreventionlifeline.org

MustangLady
on 2/4/13 2:40 am - MA

I am sure there is but it didnt sound like the surgeons office care or was even going to help. She was horrible and just said "well that is Tricare for you". I am trying not to panic though, it just stinks.

~ CJ BradleyLapband Surgery 7/2007 with many complications. 2012 Seeking Revision to RNY. 2013 Revision denied. Trying to work with band.

    

Oxford Comma Hag
on 2/4/13 2:46 am

Well, if they don't like TC, they don't have to accept it. Kick it up the chain and talk to someone else if she is unable or unwilling to help. She may not be the person who handles appeals, so it's possible she doesn't know the first thing about them.

Sure it stinks, but it's not the end of the road by any stretch.

take care

I fight badgers with spoons.

National Suicide Prevention Lifeline: 800-273-8255

Suicidepreventionlifeline.org

thynnlynn
on 2/4/13 2:46 am - MI

In addition to appealing, perhaps you might want to find another surgeon.

  Blessings,   Lynn    

Band to RnY - 3/13/13

Carol S.
on 2/4/13 2:48 am - Milwaukee, WI

You might have to sit on hold for awhile but talk to Tricare, get it straight from the horses mouth.

Carol

SW/276 CW 150 GW 185

9 Years out.
            
DebsGiz
on 2/4/13 8:39 am - FL

It is my understanding that TriCare will only pay for one WLS during a lifetime.  If they paid for your lap-band surgery, this may be the reason why you're being denied. 

Good luck!!!!

MustangLady
on 2/4/13 9:19 am - MA
No they didn't pay for my first surgery.

~ CJ BradleyLapband Surgery 7/2007 with many complications. 2012 Seeking Revision to RNY. 2013 Revision denied. Trying to work with band.

    

Sherrie P.
on 2/4/13 9:32 am
RNY on 02/06/13

I do not have Tricare, but I was denied the first time. I  was also denied the second time which was my peer to peer review. The third time I did my own appeal and was approved. 

You were probably denied for non compliance.  If that was the case, get a letter from your nutritionist saying you are following an eating plan and are compliant!

Write a heart felt letter about your craptacular experience with the Band.

It can be overturned.

Revision Lapband to RNY 2-6-2013   HW: 286  Pre-Op Diet: 277  Surgery Day: 265  Goal: 155  CW: 155

Plastic surgery 8/28/2014: Brachioplasty, mastopexy, & abdominoplasty.

Plastic surgery 1/27/2015: Butt Lift

    

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