What do you put in an appeal letter? Tricare

HunyBunny
on 9/22/08 7:13 am - GA

I'm aggravated and depressed at the same time. My insurance company declined me because I don't weigh enough. Tricare uses the Met Life standards. My BMI is 36-37? I've had a heart attack, Type II diabetes, glaucoma (even though that's not listed as a co-morbidity, my diabetes affects it), emphysema, high cholesterol and high triglycerides. Tricare made some ridiculous comment about how they consider the lower and upper range of acceptable weight for a particular height. I barely 100 lbs. over the minimum weight for my height.
What do you put in an appeal letter? Without calling them names?

[url=http://www.TickerFactory.com/weight-loss/wrXdz6C/]
[img]http://tickers.TickerFactory.com/ezt/t/wrXdz6C/weight.png[/img]
[/url]

God is always good!

HW-215, SW-201, CW-195, GW-125

I_ride_on_the_back
on 9/22/08 8:03 am

I will wait for responses from your post, i need help too.

Vicki PNW
on 9/22/08 10:43 am

DS on 05/14/08

Here is the link to appealing your insurance denial. It also includes a sample appeal letter.
http://www.obesityhelp.com/morbidobesity/information/wlsjourney/insurance+trouble.php

Hope this helps!

Vicki

DS (lap) with Dr. Clifford Deveney. Cholecystectomy (lap) with Dr. Clifford Deveney 19 months post-op.

Has not weighed myself since 1/2010. Letting my clothes gauge my progress instead.

HunyBunny
on 9/22/08 12:34 pm - GA

DS on 07/19/10

Thanks Vickie, That letter is really good and I'm going to use it. Pls cross your fingers for me. Diane

[url=http://www.TickerFactory.com/weight-loss/wrXdz6C/]
[img]http://tickers.TickerFactory.com/ezt/t/wrXdz6C/weight.png[/img]
[/url]

God is always good!

HW-215, SW-201, CW-195, GW-125

bikerbetty
on 9/22/08 2:08 pm - CA

VBG on 01/14/09

hello
I have tri-care prime and I am waiting to hear from the appeals and hearing's department because I was denied for the same reason. I was not 100lbs over and I have 3 co-morbities but they said 100lbs or more. they won't budge. i gained 13 lbs. now i am waiting for a answer.
how much do you need to gain? not that you should gain weight
I am just saying they would not budge for me at all also are you small frame or medium frame if you are small your doctor needs to put in your letter or they will go by medium frame from the met life standards

good luck

HunyBunny
on 9/22/08 11:23 pm - GA

DS on 07/19/10

On September 22, 2008 at 9:08 PM Pacific Time, bikerbetty wrote:

hello
I have tri-care prime and I am waiting to hear from the appeals and hearing's department because I was denied for the same reason. I was not 100lbs over and I have 3 co-morbities but they said 100lbs or more. they won't budge. i gained 13 lbs. now i am waiting for a answer.
how much do you need to gain? not that you should gain weight
I am just saying they would not budge for me at all also are you small frame or medium frame if you are small your doctor needs to put in your letter or they will go by medium frame from the met life standards

good luck

When I graduated from high school I was 97 lbs and continued to remain small until I hit my 30s. When I married at 37 yo, I was 115 and had probably lost about 3 lbs for the wedding. A med clinic once told me that I was a medium frame. I've thought about gaining the weight, but my husband is against it. I weighed 209 when I saw the WLS dr and I still weigh that about 6 months later. My husband is against me gaining any more weight, but if I knew it would definitely make a difference, then I would. I'm concerned that Tricare would come back and say that I was manipulating the system. I'm so aggravated with them; I can hardly do anything in life, such as bending over as I can't breathe, etc. and think I really need the surgery. Thanks for the info.

[url=http://www.TickerFactory.com/weight-loss/wrXdz6C/]
[img]http://tickers.TickerFactory.com/ezt/t/wrXdz6C/weight.png[/img]
[/url]

God is always good!

HW-215, SW-201, CW-195, GW-125

kimberly84
on 9/22/08 5:21 pm - ME

I’ve read about a lot of people gaining the weight needed in order for approvals with tricare. I wish you the best of luck-Hang in there!

HunyBunny
on 9/22/08 11:25 pm - GA

DS on 07/19/10

Kimberly, I love your avator and thanks for responding. I'm going to think about the weight thing.

[url=http://www.TickerFactory.com/weight-loss/wrXdz6C/]
[img]http://tickers.TickerFactory.com/ezt/t/wrXdz6C/weight.png[/img]
[/url]

God is always good!

HW-215, SW-201, CW-195, GW-125

Vicki Browning
on 9/23/08 1:45 am - IN

Lap Band on 08/31/07

I deal a great deal with Tricare if you need help

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What do you put in an appeal letter? Tricare

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What do you put in an appeal letter? Tricare