Tricare denied my revision now what?

Jana W.
on 10/12/12 7:12 am - Fairview Heights, IL
Well as expected I was denied.  They recently changed their coverage to one surgery per life time.  I do not know how to fight this or is it worth fighting?  Anyone been approved after being denied through Tricare Prime????
Whit
on 10/12/12 8:48 am
Revision on 12/10/12
 Do they have an apreals process? Only you can determine if it's worth it.  I think your health is worth it and so are you!
Hislady
on 10/12/12 3:11 pm - Vancouver, WA
I haven't heard of anyone winning the one surgery per life time but then I don't know if anyone has tried appealing it but it seems pretty water tight like the not covering bariatrics at all. Only you can decide if you have the time and energy to appeal. Good luck to you if you do!
pineview01
on 10/12/12 3:26 pm - Davison, MI
I don't have Tricare.  My insurance recently changed their coverage to one surgery per life time too.  So, far I have gotten them to aprove the second Psych Eval, which is the first step.  I will be fighting to the death to get the Sleeve approved.  I may not win but am fighting to the death on medical neccecity.  There has been a couple that have won here.

I had to have my band removed due to 2.5 years of problems.  I keep going round and round though.  I get the people at the insurance to agree to allow submitting.  Than the middle people call my PCP and say I can't apply.  Than I have to go back again to the insurance and go back up the ladder.  I have been since July 2nd to get the Pych Eval approved.  I just got the approval last week.

If you want it keep fighting!

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

Allen Y.
on 10/13/12 2:22 pm - Garland, TX
 It's always worth fighting for yourself.

If you have any legal friends, have them send the Tricare people a letter on their stationary. 
It implies you are willing to litigate to resolve the issue.



     

(deactivated member)
on 10/26/12 11:19 pm

Well, as of last week the Dr was appealing the denial. Part of the problem was he requested a DS which is not a covered surgery to begin with. I faxed them a copy of covered procedures so i am hoping this time around they got it right.

pineview01
on 10/28/12 7:15 am, edited 10/28/12 7:16 am - Davison, MI

If you want it, keep fighting and plugging along.

I have found out that one person ahead of me has fought my insurance company all the way thru and WON!  I once again am hoping.

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

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