update on Tricare denial

I just got my denial letter in the mail. Basically I am not sick enough for them to cover the surgery. They say I have to have one of their co morbidities to qualify since I am not 200% over ideal body weight.  So since I dont have high blood pressure or high cholesterol, diabetes ( my pre-diabetic status does not count) or severe respriatory disease I do not qualify. I have already written my appeal and I have written my pcm about him writing a letter of appeal also. Hopefully I can show Tricare the error of their ways. Keep your fingers crossed. Anyone else ever have to deal with this?  April

I am sorry that you were denied, I have a huge fear that I may be denied as well. I did not think that I had any co morbidities either but I was sent for a sleep study and diagnosed with sleep apnea which is one that the insurance counts. So if you haven't had a sleep study it could help you out if you have one and have sleep apnea which is very common in people that are overweight.

Girl you can make some up. Aches and pains in the knees, joints, back, reflux.

I have GERD and it is documented, and I take medication for it. Tricare does does not count it as a comorbidity

stress incontinence and have to wear protective pads at all times Not only can this condition cause embarrassing "accidents" in public, but it causes odors, inflamed skin and rashes as well.  It also causes me immeasurable embarrassment when in intimate situations with my husband, and I find that I sometimes resist even engaging in intimacy when this condition is particularly active.

 

 sleep disturbances. Although I have not had a Sleep Study performed, I experience sleep disturbances such as periodic heavy snoring, choking, and I seem to stop breathing for short periods of time.  This is particularly frightening to my husband when he witnesses me trying to breath but not able to inhale air.  It feels as though it stresses my heart and leaves me tired or exhausted most days before I have even started my busy day.  The weight loss would help with sleep disturbances.

 

Pre-Diabetic ... Although my blood sugars have not shown to be consistently high, I am experiencing more exaggerated swings in my blood sugars depending on what I eat and drink, and how often I do so.  I have more after-dinner energy and mood swings which appear to be at times when my sugar levels would be quickly rising or falling.  I also experience extreme tiredness after certain meals, emotional mood swings, and feeling that I could simply fall asleep where I am. 

 

Diabetes I could get it, it runs in my family, the weight loss would help me to prevent getting & suffering from diabetes plus prevent from takings meds in the future.

 

I started showing signs of High blood pressure. It also runs in my family, the weight loss would help me to prevent getting & suffering from high blood pressure plus prevent from taking meds in the future. Also, I have hypercholesterolemia (high cholesterol).

 

Weight-bearing Arthritis with severe joint, back, hip, knee, ankle and foot pain This limiting condition is ever-present and nearly intolerable. 

 

Arthritis is also a major morbid condition that I have. One of the nearly intolerable problems is the constant pain of the weight-bearing joints. An increase in body weight adds trauma to weight bearing joints and excess body weight is a major predictor of osteoarthritis. This is a mechanical problem and not a metabolic one. The hips, knees, ankles and feet have to bear most of the weight of the body. It affects every thing I do and limits me in so many activities that I am not able to perform due to the constant pain. There are times when it feels like my entire skeleton is being pulled out of joint.  Just getting up off the couch, or out of the tub, or in and out of the car can be so painful, that I need help from someone just to finish the movement.  I find I must stop and rest when doing simple errands like grocery shopping.  I avoid activities like walking up and down stairs just to save myself the added pain.  Exercising at this weight is impossible.

 

The permanent weight loss of gastric bypass surgery will markedly decrease problems with arthritis and the ever-increasing expenses to the insurance companies that will surely follow.

 

Severe shortness of breath ... The slightest amount of exertion causes me to be short of breath, gasp for air or to just constantly "huff and puff" trying to take in enough oxygen to make the next movement.  standing, or even walking to the mail box.  Any recreational activity or exercise is out of the question I become short of breath on any exertion. I cannot climb even one flight of stairs without stopping, and have a very difficult time performing the ordinary day-to-day duties of living, such as shopping, cleaning, Even though I was once physically active, (hiking, riding my bike, enjoying gardening, ect.) I am completely unable to perform any of these activities now, leaving me the outsider in my own family and circle of friends. Because I cannot control or lose the weight. Losing weight will cure respiratory problems.

 

 

 

Chronic skin Irritations problems. I am in a constant battle with yeast infections and chronic rashes in the folds of my body. Due to not being able to keep the areas dry, my skin has a very offensive odor, stays irritated, red, infected and covered in rashes.  There are times when it actually has a "slick", moist covering that cannot be washed away no matter how often I shower.  The open areas are very painful as skin rubs against skin, or when my clothing rubs the effected area.

 

 The obesity causes these skin folds so that skin rubs on skin and the moisture trapped in those creases causes the infections and rashes and an offensive smell.

 

I had knee and feet problems.  I had never been treated for them, but Dr Byrne included them in his report and it helped,  Good Luck mary

Thanks everyone for your support. I wrote a letter to my PCM and my hubby is dropping it off at the clinic today. My PCM has been out of town. I wrote him a letter because I feel that it was better to do that than to leave messages on a voice mail. I also included the appeal letter that I have written so he can read it too. Hopefully he will write an appeal letter on my behalf, he was only semi-supportive about the surgery in the first place. I do have a lot of joint pain, going up and down stairs is very painful now. Maybe that will help. I made sure I talked about it in my appeal letter. I hope to get everything faxed by next week, but it all depends on how long my PCM takes.

I am having the same problem.  I was just wondering who at you insured through (if you don't mind my asking did )? How long did it take to get an answer on your appeal?  Lastly, did you ever get approved for the surgery?  Any help/hope would be greatly appreciated.