Denial

thelinks99
on 9/5/08 5:30 am - Kittery, ME
So Tricare denied me.  They said that I needed to be 100 lbs over weight, but when I went to the informational meeting they said that it went by BMI so even tough I was just a few pounds shy of the 100, I was fine.  Well they just called me and said I was denied.  They quoted a much higher number than I have seen as my ideal weight, so that puts me way under and then they say that I've lost weight.  The fact that I've lost some weight should not be factoring into the denial.  It's not like I've lost 25 lbs or something.  I lost 9 and I'm still fluctuating.  I'm soooo upset right now.  I've been trying so hard to get healthy.  So now I need to deal with the appeals process.  Anyone ever had to deal with this?  How about with Tricare?  ~Bummed~
(deactivated member)
on 9/5/08 7:17 am
I didn't have to deal with them and I don't have any experience with tricare.  I just wanted to say that I'm sorry that you're having to deal with this.  It's frustrating.
Rosemary S.
on 9/5/08 10:11 am - East Wakefield, NH
I'm sorry you have to go through all this. Please don't give up. Go through with the appeal. Best of luck to you.
 
Michelle A.
on 9/5/08 11:22 pm - manchester, NH
Have you printed out and read through with a fine tooth comb their surgery qualifications?  That is what I did.  Does it specifically SAY in their material that you need to be 100 lbs. over weight or does it talk about BMI?  Those are the kinds of things you really need to know.  What does it say in writing.

Sometimes (I believe) many ins. companies just deny to see if someone will fight.  Check out the insurance forum as well.

Michelle
kmvanvliet
on 9/6/08 6:02 am - Manchester, NH
I don't have tricare, nor did I have to deal with filing an appeal.  I just want to say that I'm sorry you have to go this, and I hope you don't give up.  That's what they want you to do.  If you put their backs up against the wall, maybe they'll change their mind.  Do you have any co-morbidities?  That would be something like hypertension, diabetes, sleep apnea, etc.  If you do, then they may allow you to be at a lower weight.  Good luck.
"I am not the skin I'm in, but the soul within."
thelinks99
on 9/7/08 2:16 pm - Kittery, ME
Yes, the co-morbidities is what made me decide on this surgery.  It wasn't the easiest decision, but I know it is what's best for me.  I'm too young to have all these health problems.  I'd hate to see how I would be in 5 years without the surgery.  I was really upset, depressed and stressed on Friday, but I feel better now.  I just gotta do what I gotta do.  Do the appeal and if it is truly meant to be, it will be approved.  I'm not gonna give up now.  The way I see it, they will be paying alot more money in the long run if they don't let me get the surgery.  The nurse I spoke to that handled my case seemed to see why I need the surgery, so that put me a little more at ease.  It's funny because Tricare is for military families.  I'm also a disabled veteran, so I could try to use the VA, but the money essentially comes from the same place, the government.  The VA uses BMI, same requirements as PRH, but Tricare says lbs.  I think it will get approved.  I know some people weigh more than me, but they are still healthier than I.  Sorry, I'm rambling.  I just had to write this to get it out of my head so I can relax.  Have a great week!!
kirby1dog G.
on 9/7/08 11:50 am
Hi,
I've got a few suggestions.  If you have this insurance through an employer you ought to be able to speak to someone in your HR dept who can nail down exaclty what the policy and requirements are.  Also, there is a NH State Insurance Commission whose job it is to regulate any company offering insurance in the state.  The may be abloe to help you to get straight answers.  Finally, NH recently passed legislation requirening all insurers to offer bariatric covereage  and I'm pretty sure they must do so in accordance with the NIH guidance (which would be the BMI method).  Good luck Treading
umber
on 9/7/08 1:49 pm - Rochester, NH
If you slide on over to the Lightweight Forum on OH, they can probably help you.  Alot of them qualified with BMIs of less than 40 but with two co-mordities.  More importantly, about half of them are army wives and therefore know Tricare.  So hopefully if you post your story and give them some background, someone will have some Tricare appeal expertise. 

Good luck!
--umber.

Lord, give me stregth and when I lack it, patience.  

 

thelinks99
on 9/7/08 2:18 pm - Kittery, ME
Thanks, I'll give that a try.  I hadn't checked out that forum before.
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