:-( Thanks to Tricare the 19th is not going to happen

So thank you for all being supportive and realy nice to me. I know that all of you will come through with flying colors and heal quickly. Unfortunately Tricare being the pains in the neck that they are have delcined to approve me. I am sitting here writing this exactly a week before the date I was supposed to go in, so Im obviously upset. If anyone has any tips on dealing with Tricare especialy when I can prove by their standards that I am qualified. Please msg me. Thanks again and I hope to be back on one of these boards again soon.

Ohhh Elizabeth, hon I am so sorry to hear this. As for Tricare, I'm sorry I don't know. I would call them and find out exactly why they denied. Then do whatever is required, fight, fight, fight!!! Hang in there and whatever you do, don't give up. Some insurances want you to give up so they deny...eventually they sometimes approve. Just keep your head up and fight them. Big (((((hugs))))) Anna

Hello Elizabeth, see if the Military Hospital where you live will do the surgery! That's what happened to me. Tricare turned me down but Darnall Army Hospital is going to do the surgery. Military hospitals don't require Tricare's permission so maybe there is hope after all Keep your head up and keep trying it will happen for you. Let me know if I can get you further information about this. Pearl

Did Tricare give you a reason they declined (they are legally required to)? Are you Tricare Prime? Or Standard? If you are Prime, you can switch to Standard easily by going to the benefits office, and filling out a form. Date it today. Then call your surgeon's office (if they are not at an MTF) and have them re-submit as Tricare Standard. You still may be able to have your surgery next week (if your surgeon is located at an MTF you will have to find a new surgeon who accepts Tricare Standard (most do)). It's a holiday weekend - so check if anyone is manning the benefits desk today, but you could still do all this Tuesday a.m. The co-pay for the surgery varies, but I am ending up paying around $500 total - that's with all the appt. co-pays, labs, psych eval, ultrasounds, nutritinist training, surgeon fee and hospital fee). The most you can possibly pay is $1000. I know that's a lot of money, but for me it was worth switching from Prime. From what the insurance expert at my surgeon's office said approval with Standard is pretty much just paperwork. They will always approve if you meet the Tricare guidelines, 100 lbs overweight with co-morbid, or 200% over ideal weight with no co-morbid's. From what I've seen/heard, Tricare Prime gets a bit more particular - declining almost automatically the first time, requiring additional supervised diets, etc. If you switch to Standard you can switch back to Prime one year later - so it's not like a lifetime commitment, ya know? If you are already Standard and were declined, or if you are Prime and do not want to switch, I'd recommend getting on the appeal process as soon as possible - like today. Document everything. Your surgery will likely be postponed, but do not lose hope!!! I've heard many people are approved on their second try. BE SURE your surgeon's office is experienced in dealing with Tricare hoo-haw! If they're not, it'd be worth switching surgeons. Hope that helps! Feel free to email me or PM me. Margaret

Actualy for prime the requrements are the same. I meet the reqirements they are just arguing about documentation and its all piddly stuff. They are just being pains. We are hoping after my sleep apnea test (mild possibly) that it will be enough to pu**** through. I am calling the surgeon on tuesday to ask if they even saw the second reqirement and if there is a way to go from that angle.

I also wanted to ask what surgery you were planning to have? At present Tricare does not cover Lap Band. Primarily they cover RNY, but it seems like they cover something else too...not sure what. I've seen posts that they will approve lap band if done at Walter Reed Med. in DC ...maybe they're doing a study there or something.

I believe the Lap Band thing IS a study. Madigan (Ft. Lewis) will be doing a trial Lap Band program beginning this summer. I had a 'similar' experience with Tricare. In 2005 I had an off-post provider and began seeing an off-post surgeon to have surgery done. We had already started all the required pre-op appointments and Tricare decided they would not cover the surgery with that surgeon - I was referred back to the local Army hospital (Madigan) to have surgery. I was told the military hospitals always get "first dibbs" - if they CAN perform a procedure (speaking of Tricare Prime, of course), I have to have it done there before outsourcing to the civilian specialty providers. I was irritated and called the whole thing off. Then we moved on post in December of 2005 and began receiving medical care at the MTF. In August of 2006 I started the process up again, this time through the on-post providers, and everything went off without a glitch! I didn't have to "prove" my previous dieting attempts, but they did want everything to be documented. They were very thorough, but the entire process only took 5 months I think, from my first appt with my general provider to request a referral until surgery day! Don't give up! How far from the nearest MTF are you? If you are in a remote location they may approve an appeal stating that it would not be possible (or practical) for you to travel to an MTF to have the procedure done. I'm sending out lots of good luck wishes for you hun, hang on there and keep us up to date on how you're doing!

Good points, Keri! I actually had hoped to have my surgery at the local MTF (PNMC) but the waiting list was really long - much longer than I wanted to wait. Prime wouldn't approve me to go outside the MTF...even though the wait (like 18 months) was ridiculous. That's why I chose to switch to Standard.

I had Tricare Standard and switched to Prime for better coverage (100% paid versus 75%) and I was approved within 24 hrs. They didn't require any documentation or supervised diets or anything. My husband is retired, but that doesn't make any difference concerning their qualifications. Because we are no longer active, I wasn't required to try a MTF first. Do you know why they denied you? Was it because you didn't qualify under their standards or is it a matter of your surgeon or facility? You should call them and ask why you were denied and then ask them what you can do about it. I have no doubt they can help you, we've never had any problems with them. Good luck to you and let me know if I can help you any, my husband is a pro with understanding the insurance. He's dealt with them for over 25 yrs. Denise

Unfortunately I am here at DLI in Monterey CA. There is no onpost treatment for dependents at all. I believe that I am atleast 3-4 hours from a base with an actual hospital. I believe its because my surgeon was not aware of the fact that he needed to justify that I am 200% over my ideal body weight. I am right on the line and if they were to say that I had a heavy build then I dont meet the reqirements. I do not have a heavy build I am actualy a very small person. I really appreciate all of the support from all of you. It was so heartbreaking to hear that it wasnt going to happen when I thought it was.