denial from tricare south

I got a letter that says i meet the weight requirement but i am denied because i don't have a co-morbitiy!  I am takeing arthritis medications and Rx pain releavers and i know they count arthitis as a co-morbidity but will they ask for tests that prove i have  arthritis? Are there even tests that can prove it or are the medications im takeing proof enough?? please help me! What can i do??

There are tests that diagnosis arthritis, there is the Rheumatoid Factor, and there is the ANA profile. There are numerous other tests available but those are the most popular. Since your PCP has you on arthritis medication, then he probably needs to reword his letter to the insurance company. If your BMI is >40 most insurance companies do NOT require a co-morbitity. Have you had a sleep apnea test? Call your insurance company and ask them exactly what the requirements are and appeal their decision. Seems like a lot of them deny hoping you will quit fighting. Good luck.

Oh no!!!!  I have Tricare south too.  I don't have any co morbidities, but my BMI is around 60!  What is your BMI?  I can't believe that you got denied...

My BMI is 41 but they dont base it on BMI .. they base it on if you are 100lbs over your ideal weight with co-morbitities OR 200% without co-morbidities.  I am only 100lbs over so i need a co-morbidity.  I called and asked about it and they said that if i didnt have one of the co-morbidities i could still appeal (and i should appeal). If i appeal they will base it on if i can prove medical necessity. If anybody has any ideas how i can do that properly i'd really appreciate some input!  I do have a slipped disk that causes chronic pain and a few other things that i can argue with but i dont know if it will be enough to prove medical necessity.  Please pray that they are leniant on me! thanks!

I will for sure be praying!  Keep me/all of us updated!

I really hopes it works out for you.. I to have Tricare Prime North.. I have not summited my ppw yet but am sending it off today.. I have a BMI over 50 and take high blood pressure medicine.. I think i will be approved but  I keep thinking some way some how something will happen to  cause a deniel.. Like i havent tired that many decumented weight loss attempts.. anyways.. I guess we will see in the next few weeks.. Wish me luck.. And please do appeal..

I will appeal and i am SURE you will be accpeted right away! Think happy thoughts!  And keep me updated!

I have Tricare North and was denied a little over a week ago.  I am just about 100lbs over weight and have no comorbs.  I had a sleep study done and i was borderline.  I also have had getstational diabetes with both pregnancies but I guess they don't care that you WILL get those things down the road.  THey wont pay if you don't meet the requirements.  My husband just took a job with Aetna so we are going to resubmit my info with them.  I am not even going to bother with Tricare.  I am so mad.  My date was going to be March 14 th for my surgery.  Now I have to wait until April 1st just to submit my info again.  I did have the option to appeal, and my surgeons office said I should get my surgeon to talk to the Dr. that does the overall look at your paperwork at tricare, but  that takes a long time to get that done.  They also suggested contacting a lawyer on the West coast that just deals with appeals with WLS.  If you need that info I can get it to you.  I guess if you get him, it kind of scares the insurance and it shows that you are serious.  I guess it gives you a good chance.   GOod luck!!!!!!!