Recent Posts
Topic: RE: Tricare Prime Approval - North Region
Hi there,
I am in the "in process" boat. And this is for the referral from my pcm to the bariatric surgeon (civilian) Does the surgeon also have to put in a request for the surgery, or will the first one cover it? I'm thinking that's why it's taking so long? I'm getting annoyed. I have Tricare Prime North. My doctor's office put the referral in on March 1. (although I was seen on the 23rd - grrr) Figured I'd hear something other than "in process" by now. I'm trying to be patient, but my consult appointment is on Friday the 11th.
I am 5'3" and 260. I also have high blood pressure, elevated cholesterol, and sleep apnea. I sure hope I don't get denied. I hope I can join you on the losers bench, too!
Okay, thanks for listening. I think I'll give Tricare a call today.
I am in the "in process" boat. And this is for the referral from my pcm to the bariatric surgeon (civilian) Does the surgeon also have to put in a request for the surgery, or will the first one cover it? I'm thinking that's why it's taking so long? I'm getting annoyed. I have Tricare Prime North. My doctor's office put the referral in on March 1. (although I was seen on the 23rd - grrr) Figured I'd hear something other than "in process" by now. I'm trying to be patient, but my consult appointment is on Friday the 11th.
I am 5'3" and 260. I also have high blood pressure, elevated cholesterol, and sleep apnea. I sure hope I don't get denied. I hope I can join you on the losers bench, too!
Okay, thanks for listening. I think I'll give Tricare a call today.
Topic: RE: Tricare Prime Approval - North Region
03/29/2011 -- RNY @ INOVA!! Surgery went great. Weighed 260
03/30/2011 -- Discharged w/ 12 pounds of fluid WTH?? Weighed 272
04/04/2011 -- One week followup w/ PA. Weighed 259
Are you excited or afraid? I find myself oscillating between the two emotions. And I think I'm going to drive everyone around me crazy in the meantime. I'm trying to focus on my preparations for life after surgery but it's hard.
03/29/2011 -- RNY @ INOVA!! Surgery went great. Weighed 260
03/30/2011 -- Discharged w/ 12 pounds of fluid WTH?? Weighed 272
04/04/2011 -- One week followup w/ PA. Weighed 259
(deactivated member)
on 3/6/11 2:38 pm - LOUISVILLE, KY
on 3/6/11 2:38 pm - LOUISVILLE, KY
Topic: RE: Champva Coverage/Denial(long post)
Hello there,I'm sorry your going through this. If you dont have a copy already,get a copy of your coverage that specifies whether or not you have covered.If you have documented who told you it was a covered benefit and get copies of whatever code was given would be helpful too. I'm really not familar with the plan that you have,but I would definitely appeal,but I worry that if you have signed a document stating you'll pay for services if not covered you may still be responsible. It just doesnt make sense if it was a covered benefit why they would have you sign something like that? You may have to back track and request aperwork that states what they have done to make sure they did document everything correctly.Thats the only way to find out what they have done before you appeal. I hope that helps.I wish you the best.
(deactivated member)
on 3/6/11 2:25 pm - LOUISVILLE, KY
on 3/6/11 2:25 pm - LOUISVILLE, KY
Topic: RE: Aetna Appeal Letter
Hello, Try to find out specifically what they need in detail through Aetna. Call them directly speak to a rep, make sure you get the name amedocument evrything she says and date and time, and ask her what she needs from you.I hope I understood you correctly on that. I hope that helps. You need anything else,feel free to message me.I wish you the best.
Topic: Insurance denial reasons? BCBS of FL in particular.
I'm eligible on 4/8/11 to send my packet into the insurance co for approval and I am CRAZY nervous that I'll be denied. I don't know why... maybe we all have these fears. Anyway, if you were denied, why were you?
Also, if you have BCBS of FL..... what has your experience been with them? Were you denied, if so, why? If you were approved, was it a fairly easy process? Approved the first time you sent your info?
Thanks!
Ginger
Also, if you have BCBS of FL..... what has your experience been with them? Were you denied, if so, why? If you were approved, was it a fairly easy process? Approved the first time you sent your info?
Thanks!
Ginger
Topic: RE: has anyone had their nutrional counseling or phsy eval done on base
Hi. I paid for mine out of pocket. I used the NUT the surgeon uses and I got that done for $85. Tricare would not accept the on base Health and Welness Center counseling as that is not done by a licensed NUT. The phsy eval I paid for myself also. Call around, let them know what you need and get a good price. I finally got it down $250. The docs office had a $250 "administrative" charge that tricare wouldn't pay so I had to cough that up too, but it will be worth it.
WE ARE ALL IN THIS TOGETHER! LET'S GET HEALTHY! 
STARTING WEIGHT 211.8, SURGERY 23 MAR 11; ONEDERLAND 30 MAR 11 199.2 
Topic: RE: Tricare Prime Approval - North Region
Congrats! Tricare Prime and I get my RNY on 23 Mar!
WE ARE ALL IN THIS TOGETHER! LET'S GET HEALTHY! STARTING WEIGHT 211.8, SURGERY 23 MAR 11; ONEDERLAND 30 MAR 11 199.2
Topic: RE: Anyone know if Medicaid will pay???
Hi I just got GA medicad in january and began my search for a bariatric surgeon that would accept it with the help of my cousin I found peachtree surgical bariatric at atlanta mcal center they except amerigroup and peachstate which are medicaid HMO's I hope this helps you in your journey Good Luck
Topic: RE: External appeal
Hi Sandy,
My external appeal was submitted at the end of June and I didn't hear anything until September. It seemed to be forever! It was worth it though because I was approved! Good luck!
My external appeal was submitted at the end of June and I didn't hear anything until September. It seemed to be forever! It was worth it though because I was approved! Good luck!
Duodenal Switch on February 21, 2011
Surgery weight: 276; Current weight: 122; Height: 5'5
Plastics scheduled for 10/3/14: BL/BA, LBL, TL
Topic: RE: External appeal
Hi there-
I know your post is many, many months old, but I just wanted to ask you a few questions about your external appeal. I am trying to revise from RNY to DS and have Aetna. My plan does not pay for out-of-network coverage for bariatric surgery, and all of the DS specialists who do revisions are out-of network. After my first appeal was denied, I contacted Walter Lindstrom. He wrote a kick-butt letter to Aetna that I thought for sure would get me approved, but they denied me again just yesterday for the same reason (no out-of-network benefits for bariatric surgery). I believe our next step is the external appeal. Can you tell me how long that particular process took for you? I'm so glad to see that you finally got your DS!!! I hope to be able to say the same eventually! I'm so miserable!!
Sandy
I know your post is many, many months old, but I just wanted to ask you a few questions about your external appeal. I am trying to revise from RNY to DS and have Aetna. My plan does not pay for out-of-network coverage for bariatric surgery, and all of the DS specialists who do revisions are out-of network. After my first appeal was denied, I contacted Walter Lindstrom. He wrote a kick-butt letter to Aetna that I thought for sure would get me approved, but they denied me again just yesterday for the same reason (no out-of-network benefits for bariatric surgery). I believe our next step is the external appeal. Can you tell me how long that particular process took for you? I'm so glad to see that you finally got your DS!!! I hope to be able to say the same eventually! I'm so miserable!!
Sandy
Most Active
Recent Topics
My insurance will not pay for my excess skin that hang down to my knees
Hockeymom87 · 0 replies · 608 views
Hockeymom87 · 0 replies · 608 views
