Denied again .............please help!!!!!!!!!!!!

I am so confused, I was denied again by Tricare.  They say that the RYN  surgery is not a covered benefit of Tricare. I have a BMI of 36.6, severe acid reflux, diabetes and severe pain in weight bearing joints.  Why am I being denied. Can Somebody please explain why this is happening?

I wish I could explain to you.  It seems crazy at times!  I'm waiting and hoping for approval for Lap Band by United Healthcare.  From what I understand, it may be tough, because like you, I have a lower BMI.   I just wanted to drop a line and tell you someone/somewhere on these boards should be able to help you get your surgery!!  Have you heard of Vicki, "The insurance guru?"  She always helps people with their approvals, denials, and appeals.  I don't believe she charges anything.  I saw on the insurance forum where she had posted some.  Contact her.  I'm sure she will be more than glad to help you. If you need to talk, please contact me. Thanks, Melissa

COULD YOU TELL ME HOW TO GET A HOLD OF VICKI "THE INSURANCE GURE???  i COULD REALLY USE HER HELP.

Sure!  All you need to do is start a post on the Lap Band site stating "I need the Insurance Guru!"  or something similar.  Her name is Viki Browning. You may even locate her, by seeing where she has replied to other people's posts and you can PM her.  That is how I contacted her.   If you need anything else, please let me know. Thanks, Melissa

Thanks Melissa your support means more than you know to me right now.

On your statement of benefits there should be a number to call and ask why the denial?  Tricare does approve RNY and Lap Band. When you call the number, make sure you write down the date, time, and name of the person you talked to.  Ask them why it was denied, write it down...then ask for the person reviewing.  I know that mine was reviewed in San Diego.  This could be something as simple as the wrong code, the form filled out improperly, or missing documentation. 

Just found out I need to gain around 10lbs

I'm sorry they are making you gain another 10lbs!!  That is ludicrous!!  However, on a lighter note, if that's all that's in your way, you're almost there!!  Yea!! Best of luck!!  You'll have your surgery in no time!! Melissa

that explains it.  They do not recognize the comorbities you have.  So, they are going by the theory of you have to be 200% over your ideal body weight.    10 lbs is not too bad.  Heck before surgery I could gain that in about 3 weeks.  Good luck