july 29-2 denials and 2 apeals running simutaneouly

well the primary denied be because of thier silly diet regiment rules, and the secondary says i'm not fat enough, can't win, both are in apeal.

Would the outcome have been different if you had opted for the RNY instead of the DS? Your BMI doesn't seem high enough to warrant all that extra malabsorption that goes along with the DS,IMO....

hi, no, aetna was only asked for the rny, but denied for diet history, which i expected as i had a heated discussion with the office manager at the pcp office, thats why i have my union getting aetna to explain what is expected of the pcp to comply with. the denial is on hold, as my union got in thier case before i knew i was even applied for. tri care denial is not yet official either, i learned, the doctors assistant said it was because of my low bmi, but the rule say greater than 40 with out comorb,but i have 5 comorbs, service connected too. but they were asked for the ds and the approved that. so the issue for a nurse to sighoff on is the comorbs, hopefully positive gotta wait until wednesday.or so.

Walter, I didn't think tricare covered anything except RNY - that's interesting....maybe because I'm TriWest... Good luck, Maria

AFTER (IF) TRICARE PAYS FOR THE DS, I WILL POST THE ApPROVAL DOCUMENT FOR ALL TO USE IN THE WAR. tri care should be the same for all us all,not dependent on the regional vendor. but i did ask on the phone and by question spicieficly about the ds and was told it was excluded. the aproval was a surprise, but my case history does excude me from haveing a rny, it is surgally imposible for me to have a rny.

Good luck with your appeals. Debbie

Walter, Just wanted to wish you luck. Hang in there - my fingers are crossed for you! Let us know! HUGS Kimberly