Tricare denial

Is there anyone out there that has Tricare and was denied and then filed an appeal and was approved??  I was referred by my PCM for WLS and I've been in a program at Portsmouth Regional Hospital in NH.  I've been in the program for ten months, completing all the requirements and having lots of testing.  I also finally met the surgeons pre-op weight loss requirement.  All I was waiting on was approval and BAM!!  Tricare called me today to tell me I was denied because yes I was over a hundred pounds over my ideal weight with a BMI of 40.9 but I don't have any co-morbidities (YET)!!  I definitely want to appeal but wonder if it will do any good.  Has this happened to anyone and what did you do and what was the outcome.  I would appreciate any help and/or feedback.  Thanks so much.  I'm beyond devastated.

 APPEAL APPEAL APPEAL!!  You have a fighting chance if your appeal is reviewed by an actual Bariatic surgoen and not some random MD.   APPEAL.... there's another poster - I think her name is Carmelita who's post you must read.  It's really good to.  I believe it's on this board.

In my case... I was denied 4 days ago for VSG due to investigastional.  I have appealed.  They have 30 days to respond.

Best for your success with your appeal,

TO Be Me Again

First off, Tricare does not use BMI for qualifying they use the Metlife table.  recommend you google for it.

Find your height, and use the medium frame as default and this will give your weight range.  You have to have comorbs if you are 100 lbs over you ideal weight. 

To see if you qualify under the 200% ,  take the minimum weight  on the metlife table and multiply by 2 and this will give you the 200% mark. 

This is the one thing they are strict about.

I was just over the 200% mark with no comorbs and was approved with no problems.

Also, double check what was submitted to Tricare and have your height rechecked and your starting weight.