Denied by Tricare Prime

Hi Sweetie,    I am right where you are. I have BCBS of TN. I have been trying to get approved with Dr. Madan in Memphis & was thinking of changing to Dr. Weaver because his office was no help. I did a yr. of testing. Everything my insurance & surgeon required. At 13 months of going back & forth sending to surgeons office & her half sending to the insurance they told me they received my denial letter. It has been 3 weeks & I have not received one in the mail. A lot on this board say you almost always get denied the first time. I am going to appeal but I had surgery on my arm Mon. so, I am waiting to get it better. Does Dr. Weavers office help with your appeal. Mine does not at all. Oh, I have a bmi of 46, no health issues but 150 over-weight. I am 49. Best of luck, Ellen

Hang in there Amanda!  Right now I no things don't look good, but hang in there!  What ever you do...DON'T GIVE UP!  thats exactly what insurance companies want!  You are in our prayers!  

Hi Amanda, this is routine for most insurance companies.  Find out what else they want, and like Scott said "DON'T GIVE UP" they want you too so they don't have to pay.  But you hang in there and fight the fight of getting your surgery.  By the Way, Scott does excellant losers benches when you become a loser.  I'm going to print mine out and frame it. 

May God travel with you on this journey.  Kathy

the same thing happend to me I have tricare prime I was referred to dr steelyat gateway memorial  went through the whole process from a- z and got denied  i was bawling I was so discouraged .I went back on post (Blanchfeild hospital Fort campbell KY) and asked for help with an appeal the Nurse pracitoner said I shoul djust put in a request to be reconsidered for the surgery by the new surgeon on post and there is a surgeon there doing the procedure Dr Sanborn,A wonderfull kind caring person(not to mention the most handsome man ive ever seen) LOL!. He had me do another nutrition class another endoscopy and the whole process was done In a matter of two weeks I just had my surgery last monday on the 17th . I did not have to wait for tricare because it was on post .he did it laproscop in I am so glad I did not wait for the whole appeal process .But what ever you do dont give up .  I wish you the best of Luck  write me anytime  Pam

Hi.... I live in NE Alabama and have TRICARE Prime. I was approved right away, no problems at all. Had Lap RNY in Dec 2005, and had my TT/BA/BL in April this year. They paid for the TT...the BA/BL was my expense. They have been a breeze to work with, at least for me. MAybe it was the way things were coded? Did they say why you were not approved??? Good luck to you.

You look great. Congratulations!!!!!!!!! From what I can tell Tricare Prime is great for some and terrible to others. My package for appeal was sent in today. Here's hoping that I can stop being the "before" picture. Amanda

Thanks....you are sweet to say such nice things. I am hoping for the best with your appeal. What was their reason for denial?? Keep me posted on your progress!! "After" is a great place to be!! My life has changed so much......I am still amazed almost daily!!   Hang in there......

I am Tricare Prime and I didnt get denied. I was barely a 40 BMI also. I did have my surgery in MA though and not TN. I would contact your HBA and see if they ahve any ideas as to why they denied you. It sounds to me like you should have been approved no problem. Sometimes with Tricare ya gotta fight em, as Im sure you know! Good Luck! :)