Recent Posts
Topic: Im Approved!!!!
I finally got the call from tricare today. I almost started crying when I heard her say I was approved. And, I already have my surgery date! I get admitted into the hospital on Sept 10th for all my pre op tests, and then on the 11th I have surgery. WOW!
Now the next major hurdle in this is, Getting someone here to help out with the kids. My husband will be deployed at the time of the surgery. But im almost sure my mom can make the trip to Germany to help me out. WOW WOW WOW!!!
-Mary
Topic: RE: Denied by Tricare Prime
They are going by BMI now, according to my dr's insurrance gal. Your BMI has to be over 40 or 35 if you have serious comorbidities. They were requireing that you had to be 100 lbs over your ideal weight. I'm not sure if that still applies. Good luck with your fight. Diana
Topic: RE: One more step
My Psych eval is the thing that is going to take the longest, so I am anxious to get it out of the way. I am not looking forward to someone analizing me. Around here it doesn't take long to schudule surgery after everything is ready. Hopefully we will both get approved. Diana
Mommy O.
on 7/4/07 9:28 am
on 7/4/07 9:28 am
Topic: RE: Denied by Tricare Prime
Well, Im glad you have so much support! The doctors i have seen for the most part could care less.
I was denied because i need a co-morbidity too. I was re-evaluaded just 2 days ago and everything is going to be re-sent to tricare. I have hypertension, and that wasn't reported before, and i also have PCOS and back and knee problems so hopefully it will be enough to get me approved this time.
One the doctors at an MTF told me that tircare has changed some policies since so many soldiers are comeing home with serious injuries. They are makeing it harder to get some things done. For example plastics are supposed to be covered but now alot of people are being denied and if they are approved they have a large co-pay.
I honestly don't know how much of that is true because i haven't seen any policy changes on the tricare website so it doesn't really make sense to me that they would make changes and not inform people you know?
Well, good luck getting approved. Let us know how things are going for you 
Mommy O.
on 7/4/07 9:06 am
on 7/4/07 9:06 am
Topic: RE: One more step
Thats so exciting
I need to do my psych eval too. Im kind of concerned because it's just weird haveing someone evaluating you to see if you're crazy or not.
Also, part of me wants to wait until i get approval from insurance because by getting the psych eval done i am also kind of admitting that i am hopeful i will be approved this time and its kind of like that really good thing you don't want to share with everyone for fear it won't come true. I feel like im jinxing it.
.. oops .. totally got self centered there for a min. Everything will turn out great! Just keep picturing yourself in your new itty bitty bikini :D
I need to do my psych eval too. Im kind of concerned because it's just weird haveing someone evaluating you to see if you're crazy or not.
Also, part of me wants to wait until i get approval from insurance because by getting the psych eval done i am also kind of admitting that i am hopeful i will be approved this time and its kind of like that really good thing you don't want to share with everyone for fear it won't come true. I feel like im jinxing it.
.. oops .. totally got self centered there for a min. Everything will turn out great! Just keep picturing yourself in your new itty bitty bikini :D Mommy O.
on 7/4/07 8:52 am
on 7/4/07 8:52 am
Topic: RE: Appointment today.
I am 100% over my ideal weight. But tircare is asking for a co-morbidity in addition to that.
Originally no co-morbidity was reported to tricare. I was denied because of that. Then we appealed and submitted the co-morbidity but i was denied again. This time with no explanation as to why.
I talked to tricare and so did my PCM and my surgeon and we were all told to go ahead and get re-evaluated and resumbit everything as if it were the first time. I was told that sometimes when things are not done a certain way the denial is automatic even if the person qualifies for the proceedure. I was also told that alot of it depends on the person reviewing the case. I think its all really unfair but i guess thats life. I'll just keep tring.
Topic: RE: Denied by Tricare Prime
That is really odd that they denied you! You do seem perfect for it. I was so upset when I got denied, but then my boss told me that a lot of insurance companies eny things like that to see if they can "turn you away" from it and save them money, and she said that once you appeal you have a better chance. I don't know...it made me feel better though. Just make sure that you submit all the documentation for the appeal. I also included a letter that I wrote with mine, explaining why the surgery wa necessary for me and that I knew the lifelong changes I would have to make. I also quoted them from the handbook and went on to explain that I did meet their criteria. 
And I had my doctor include a letter stating why this was medically necessary. Keep your chin up. Persistence pays off!!!! I'm living proof of that.
And I had my doctor include a letter stating why this was medically necessary. Keep your chin up. Persistence pays off!!!! I'm living proof of that. Most Active
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