Tricare Prime denied me

This is my first denial. I'm so ****ed. Now I wait on my letter so I can appeal. I am seriously thinking of going to Darnall here on post and trying to get the surgery. I have read and heard that it is easier when you get it done on post. Any advice???
Thanks,

First, what reason did they give for denial?

Please note that Tricare does not use BMI, they use the met life table (google) and they are very strict in this part of quailification.  You have to be a minimum of 100lbs overweight with comorbs or 200% over your ideal weight.  If you are not one of these, it can be a tough road to being approved.  If you do have an MTF that does the procedure, then I would definitely check it out.

Oh, they will deny also if they are missing paperwork that they require.

Good luck.

texgirl66
I'm near Killeen also and trying to get approval myself. My question to you is does Darnall perform these type procedures? I couldn't find much online and fairly new to this area.

Hate to bump a 2 week old post, but just wanted to say that i'm sorry you were denied. I am waiting to find out if i'm approved right now and i'm so nervous about it. My surgeon says that he's been dealing with a lot of denials in the past few months, i'm not sure if Tricare is cutting down on people doing it or what? He said he just had a girl in last week who was denied in less than 72 hours from when the paperwork was submitted. Tricare stated she wasn't overweight enough at a BMI of 41.4 and suggested that she gain an additional 15 pounds. The doctor was really frustrated at this. Now i'm worried I will be denied too I think my BMI is 42 and I KNOW i'm more than 100 pounds overweight. But I don't really have any co-morbs other than reflux from a large hiatal hernia....and I don't think that counts.

Are you trying to use civilian doctors?  I am going through an MTF and I don't even have to get approved.  In fact, the whole process has been so easy it's kinda scary.  I am sorry you are having trouble.

PS - Tricare does use BMI now...I will find the new link and post.

Tricare uses the BMI now??? I just went to their website 2 weeks ago and it still mentioned being 100 lbs. overweight with co-morbidities.

We are stationed @ Fort Benning in Georgia and there isn't an MTF around here who does Weight Loss Surgery. My only options were either seeing a civilian doctor in Columbus (the city Ft. Benning is in) or driving up to Atlanta and seeing a civilian surgeon up there. It worked out for the best because I LOVE my surgeon here in Columbus.

I just found out today that I am approved for the surgery and the hernia repair. I am SO excited! My BMI is 42.1 and I have no co-morbs. My "packet" was submitted yesterday at 1 pm and was approved today by 2 pm. That was quick!