I was denied.

Hey everyone. they sent in my packet to tricare and it was a no go. My husband made a good point and im hoping he is right. they sent it in under the wrong listing i guess. I'm 100'bs over weight not 200lb. He said it was probable kicked out by a computer or something. I sent a letter to them for reconsideration. so we will see what happens.... anyone ever have this happen to them? how long was there wait? shell

Maybe he's right....maybe they looked at your current weight and said (for example), ok she's 250 lbs and she wants to lose 200 lbs??  No way!  And denied it.......or the computer somehow kicked it out for that same reason.  I hope you are able to get it straightened out and get approved!

I hope it alll gets straighten out. Insurance companies just like to make people sweat. Good luck Laurie 

Shell- Do you have any co-morbidities?  The Tricare policy is 100lbs over ideal weight with comorbidities or 200% over ideal weight with no co-morbidities.  They use the Met Life weight tables to determine ideal weight. I would be gathering all of the info I could to send in to document the co-morbidities that Tricare recognizes.  I have included a little blurb from the Tricare policy.  Let me know if you want the whole policy. Red

A. Gastric bypass, gastric stapling or gastroplasty, to include vertical banded gastroplasty is covered when one of the following conditions is met:

1. The patient is 100 pounds over the ideal weight for height and bone structure and has one of these associated medical conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints.

2. The patient is 200 percent or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category.

I hope it all works out for you, my Tricare office seems very helpful. please post and let us know how its going for you

Thank you all for your comments. I did write tricare and they opened my case back up. the fact that it is still open is a good sign to me  We will see what happens and if this doesnt work its back to the doctors for more test.. I wont be giving up! I thank you again for your support!! I'll keep you updated! ~shell

If you haven't done it already, get as many of your doctors to write letters stating why you need wls & send them with your appeal.  I sent letters from both of my orthopedic doctors (knees & back), pulmonologist, chiropractor as well as my PCP.  If I were younger & wanting to get pregnant, I would have also gotten a letter from my OB/GYN but that was no longer an issue for me. Good luck! Vickie J.