crisonclovr
Denied for the 2nd time...Tricare SUX!
Oct 19, 2007
chart was lost so she said she didn't know of my past history of weighing 300#'s & a liftime of yo-yo'ing. Hello, did she not take notes at our initial meeting?
She said that Gastric Bypass is a form of starvation and really an easy way out...WHAT?!..& that all of her patients have gained
thier weight back...wow, way to be supportive! Of course she is a tiny lady of 5 foot in heels and possibly a size 2, no kidding.
She said I need to cook for my family just barely enough & never
give anyone seconds...Ok, I just felt like I was talking to a un-real person.
She did tell me that at least I was pretty in the face and I kid you not, she then laughed!!!...WTF!? OMG...freakin' RUDE!
So being bigger in the body area is not pretty at all? She is a tool!
O-well, me and my laughable pretty face and fat ass will get
along just fine! LOL!
My account @ Tricare is noted that Appeal....
Oct 16, 2007
Halloween @ Bopmyspace.com
was rcvd. yesterday & that all appeals are sent out somewhere else rather than the original place it was sent to (the 2nd level review board)....so we will see. doing good, just getting hubby ready for another deployment...just a few weeks away. take care everybody!
Faxed to wrong#
Oct 11, 2007
Called Tricare and spoke w/a gal in the 2nd level review board who gave me a specific fax# and her name.
called surgeons office and asked them to fax it to that number.
we'll see.
Appeal Faxed by Surgeons Office...not holding my breath!
Oct 11, 2007
Halloween @ Bopmyspace.com
I am happy that they did fax that Appeal for me. It was done this past Friday @ 4pm..it is now Thursday and Tricare has not rcvd./and or logged it...they are using Columbus Day as an excuse for the lag.
I heard we are able to Appeal 2x....so I have additonal medical records to attach to that 2nd Appeal if it comes to that. Unfortunatley when we transferred last my medical record was lost and it took some sluth work to obtain them from the actual doctors office.
So this has become a part time job...but that is fine.
Everyone have a great day!
A Glimmer of Hope
Oct 05, 2007
Dividers @ Bopmyspace.com
I just rcvd. an e-mail from the Ins. Pre-Determination gal from my surgeons office...she submitted my appeal letter via fax to Tricare's Review Department.
So we will see...2nd day of not binge eating and I feel better physically and mentally. Worked out in the yard between rain showers and really boosted my Seratonin levels.
So everybody have an awesome weekend.
Protien Powder & Protien Sweet Tea & new walking clothes!
Oct 04, 2007
Dividers @ Bopmyspace.com
I LOVE MY HUSBAND! He is so sweet and gentle, but also knows when I need to be pushed in the right direction...he told me to get up...be happy...
go to Wally Mart...get some new walking clothes, capris & t-shirts...go get
some Choc. Whey Protien Powder and new single serving blender.
I also found that Special K makes individual Sweet Tea Lemon protien powder packets & it is AWESOME....So I may be "Denied" for Gastric Bypass for the time being.
But I cannot deny myself living. I kinda gave up the last couple of days and just plain out binging myself sick. So for now, I am not "dieting" yet going down a street called "get on with it!".
One protien shake a day instead of 2 double $1 cheeseburgers &
$1 french fries and a large $1sweet T @ Mickey D's.
For ONLY $4 dollars a day my arse has its own shadow!
Just by replacing that one McCrappy meal w/one Protien Shake a day...
and going for my walks that I love with my kids a few times a week...that
will make me happy.
And I will no longer allow this DENIAL to ruin me...Again, I will still appeal it...and life goes on. 
Denied will send appeal anyway...
Oct 03, 2007
Dividers @ Bopmyspace.com
....even though the Tricare 2nd Level Review rep said it is going to be denied again due to the fact that I am not 200% over ideal body weight...that would be 260lbs-310lbs. Being that I do not have any co-morbs (the kind they recognize). Now this is the first time in my life I wish I would have never lost any weight...I mean if you are going to have the surgery, they make you go on a diet before surgery anyway. But the rep at the Tricare 2nd Level Review board said that she "technically" can't tell me not to send an appeal packet...but she wanted to give me a heads up since she could tell by the notes in my account how many other reps told me it was denied for "Lap Band" and to not appeal and how many said it was denied because my surgeons office left something out.
So as a recap to yesterday...my surgeons office asked that I fax to them an appeal letter and she would submit it for me....took 2hrs to write one...faxed it to her & today Tricare said they were never faxed anything or called...I left my surgeons office a voicemail and she hasn't returned it. Maybe tommorrow.
My 2yr old did well with getting tubes placed in her ears. And hubby is looking like he was smashed in the face after his sinus surgery. mY house is looking like an infirmary tonight. But I am so happy he had this done before going back to the Gulf next month...the weather over there really messes w/his sinuses. *hugs* to all, have a goodnight.
Tricare WhyCare?
Oct 02, 2007
Dividers @ Bopmyspace.com
Soooo, I called Tricare and this rep said it is not denied for Lap Band...Ok, comes to this, spoke w/a supervisor and she said it was denied for Lap Gastric Bypass and that the reps were seeing the "Lap" portion of it and assumed Lap Band. OMG! So yes, I was Denied...I should be getting the letter today. Anyone know any good appeal letters? She said it looked like I didn't weigh enough. WHAT! I am going to enclose pics of me naked! That would change anyones mind! BMI over 40 over 100#'s overweight, I think that my package submitted may have had something vital left out...I am asking for that package from the surgeons office to be faxed to my husband at work today so I can go over it & submit it w/my appeal.
This is an insurance that my husband works hard for and that I go w/out him and so does my kids most of the time...I am over 200% and have high cholesteral and had gestational diabetes both times and a family history of it on both sides. And depression...more of it now! Back, knees and ankle pain. I am so wanting to help myself get this approved and I feel so left out when I see others who have Tricare Prime and no co-morbids getting apporved...Was a cranky person reviewing my package? Holy cow I am ranting. And, stalking the mail man looking for my Denial. Luckily he is super sweet. But I need to not turn into a troll. I have a super husband and 2 awesome little monkeys who love me. Great new friends who I would have never met had I never pursued this surgery...so I have to stay positive and PERSISTANT. Odalys said to not make anymore calls to Tricare and to let her do her job, but that is hard for me...I am a go getter & not a bystander...especially if i want something bad! Also I know that my hubby & my youngest daughter are both having surgery tommorrow and then my husband goes back to the Gulf for 7 months soon. I am trying to just get it all done and am P.O.'d over this hurdle, I should have never listened at the surgeons office when they said my paper work looked good and I will have no problem and I know better than that too! Dang! Also reading all the other post on OH stating how easy Tricare Prime was and especially w/having the same stats as mine...I am just being immature at the moment but why ME! So I am going to go work on some Halloween decorating with my kids and get the house picked up....those little things effect the people I love the most...Mi Familia! And special thanks to my OH familia!
Lap Band Denied, Gastric Denied, My sanity DENIED!
Oct 01, 2007
Dividers @ Bopmyspace.com
I called my surgeons office & the Ins. gal said she would call Tricare to find out what is going on. I call Tricare myself and find out that they denied me because it was sent as a CPT code for Lap Band. Another Tricare rep said something different. So I went to our Naval Base Tricare rep and she said for me to prepare to submit an appeal letter when I get the denial in the mail. I call my hunny and he called Tricare...they told him NOT to appeal because I would be appealing the Lap Band and they would automatically deny it again...I WANT GASTRIC BYPASS!!!!! I KNOW TRICARE DOES NOT COVER LAP BAND! OMG! So I call the surgeons office and she advises me to let her do her job and she will work on it.
I do not like having any control and one person says another is responsible to rectify this and the other person points the finger at the other...even my Blog sounds nuts...see what this has done to me! 
Ok, I am going to hand out with my family right now...need to settle down.
Keep on Keepin' On!
Sep 28, 2007
Dividers @ Bopmyspace.com
Well, supposedly Tricare Prime Ins. faxed a "request" to my surgeons office today at 12:56pm...called surgeons office @ 2pm & "Surprise" they hadn't rcvd. it...called Tricare back and the rep placed me on hold & called the all exclusive "Referral Dept." and had them re-fax it to my surgeons office to a fax# & name of a contact there that I supplied.
Let's hope that Monday when the gal is back in the surgeons office who deals w/this stuff, she is able to help out with the elusive "technical denial".
I am starting to feel like Gollum looking for my "preeecious"!!!! 
Precious being "APPROVAL FOR SURGERY"!
Yesterday was my 34th B-day 
, today I feel like acknowledging it, hanging out w/my family...and many thanks to my "OH Family", you guys are amazing and I hope that you all know that!
*HUGS*
