Devestated

I am absolutely devestated!!  I've been going through the program at PRH now for ten months and finally completed everything.  I just received a call from my insurance company (Tricare) that they were not going to approve my request for surgery because yes I was a hundred pounds overweight but I did not have any co-morbidities (YET!!).  I am crying my eyes out and I don't know what to do.  After ten years of being overweight I finally saw a light at the end of the tunnel and pictured a healthy mom running around with her three little ones and now I feel like that dream was just taken away from me. Help!!  What do I do now??  Has anyone had this problem and/or with Tricare??  I'll take any and all advice.  I just can't believe they paid for me to go through this program for ten months only to say no.  I'm so sad!!  I need some support.

I'm so sorry you were denied by Tricare.  I have Cigna and it wasn't easy getting approved.  I didn't have any co-morbidities, however, my PCP wrote in her notes that my cholesterol was elevated (235), I had foot pain and back pain.  Is there any way you can get your PCP to say this is medically necessary?  Are you pre-diabetic?  Obviously being 100lbs overweight is an obvious sign that you would be healthier with the surgery.  I wish I could kick those ins. people.  Why they make it so hard for us to have the surgery is such a mystery to me.  Why on earth would we go through so much work to get all the required stuff done just to be let down in the end.  Again, I am sorry.  I would keep at them.  Give them as much info. as possible.  Maybe Tricare denies with hopes you won't fight to get it approved??  Don't give up.  Good luck!

Lisa 

DO NOT GIVE UP.  Call Dr. Looser's office right now, and tell them you need them to push harder to get this approved.  Also, you could look into getting an advocate for you.  I know someone who did that, not for this surgery, but for something else, and they finally paid for her care.  Call your PCP, ask him or her to get involved.  You are facing a large bump in the road.....don't let it become a crater.  Be proactive.  But you can cry today!!!   

I cannot believe that insurance companies think it is more cost effective for someone to remain obese, and pay for everything related to that, than pay for the surgery that will reduce costs all the way around.  I guess it is because the more you have wrong with you...the more the can charge you.  Don't let them have the final word.  Keep working, and don't give up.  You are worth it.

Thanks for the kind words.  I called Dr. Looser's office and Betty told me they don't help in any way to get approval and since Tricare said I didn't qualify then I didn't have any reason to appeal.  I was very shocked and saddened by that attitude from the staff.  I thought they would say to fight.  Well I definitely will fight and appeal this decision.  I guess I'll start with my PCM and start the appeal process, hopefully they will give in if I bother them enough.  Keep your fingers crossed for me.  I almost went crazy off my diet today with this bad news but I kept it together, thank God.  I truly appreciate the responses and kind words.

I would not take Betty's word as the final say.  Call or email Nancy and tell her the situation.  See what she says.  Don't give into food either.  It is not worth it.  Stay strong, but call Nancy.

I'm really sorry to hear your news! Have you checked out the Insurance, Cash Pay and Financing Forum on thsi site? You might have better luck finding someone who's gone through the same thing with Tricare on that boad. They might be able to help you out.

Here's the link to that message board:
http://www.obesityhelp.com/forums/insurance/a,messageboard/

Good luck!
~H

Stacey,
I'm so sorry to hear your news. I can't imagine going this far and being told NO. However, please don't give up...it just means you've got to appeal and jump through some extra hoops to get there. I think it is awful that they didn't approve you. But don't give up. Do some research, make some calls, and stick to the food plan and all of the things you've learned over the past 10 months and it'll happen for you too. I'm sure of it.

Blessings...
Diane

Thanks to everyone for their support, I really appreciate it.  Right now it means the world to me.  I'm trying to remain positive and stay strong.  I guess if it's meant to be it will be.  I'm going to try and find some people who have gone through this with Tricare and see how they made out.  Thanks again to everyone.

Hi All,

I wanted to let you know that I talked to both Nancy and Dr. Looser's office about this unfortunate situation. They feel really bad about this.  I'm sure you'll hear this directly, but Dr. Looser has reached out and will be working on an appeal for this case.  From my understanding, though, Tricare can be tricky.  Good luck and please know that our program supports your incredible effort.

Best regards,

Grant Sanborn
Portsmouth Regional Hospital
wwww.portsmouthhospital.com  
Parkland Medical Center
www.parklandmedicalcenter.com

Grant, I don't know you but I really appreciate your help in this matter.  It is so wonderful to have such a great support system in place.  It means the world to me.  Dr. Looser called me this morning and he was so upset about my denial and he is going to write an appeal letter for me and help me to get approval.  To have a surgeon care so much about his patients is a God send and his support and efforts are truly a blessing.  I cannot thank everyone enough for all the help and support.  I truly appreciate it from the bottom of my heart.
Stacey Carse