Denied...appealing

I got the letter yesterday notifying me Tricare denied my surgery based on my dietitian's report. (I found out last Friday she de-recommended surgery do to labeling me as an emotional eater. Tricare wanted me to be reevaled by my psych.) I did that yesterday. I'd also gotten my dietitian to write up a letter on my behalf, stating at this point I AM good to go. Nothing was submitted by their deadline, hence the denial. I wrote my newest letter last night, and am doing an expedited appeal as of today. My husband's faxing everything over asap this a.m. My psychologist should have something from my testing yeserday to fax over today....well as long as I was found stable enough.... So I'm once again waiting. My mantra for today....persistence....I will move mountains when I have to!

Kristen..... First of all (((((HUGS))))) coming your way. I am glad to see you are willing to fight for what you want. Great mantra, move those mountains girl!! You seem like you are ready for the fight and that is a good thing. I wish you luck and hope this time around you get the approval you want. I believe in this surgery, and believe anyone who wants it should have it. Good luck, and let me know if there is anything I can do for you Dianna

Thanks Dianna! I just read your post and did the questions...how funny! Hope you feel better!

Hi Sweetie...((((HUGS))))) I am so proud of you for fighting these insurance companies. They can be a pain but don't give up. Persist until they get tired of hearing from you. My thoughts and prayers are with you. Hugs, Betsy

Thank you Betsy!!! You are so wonderful! I just spoke with my psychologist. The only clinical finding, and it is minor was I express anxiety physically--meaning when i get anxious or whatever I get headaches, stomachaches. She said that's pretty normal. So she's vouched for my ability to soundly have surgery. WOOHOO!!!! She mailed me the info, hopefully I get it today and I can fax it out, either today or tomorrow will work. Any ideas on where i can fax from? I know thast sound slike a stupid Q, but we just returned from overseas 8 months ago and I haven't had to do this. My husband has been faxing stuff for me, from his office.....an hour away.

Kirsten, Tricare can be frustrating! I'm so sorry you got denied but I bet that with the new reports they'll approve you fairly quickly. If you're registered with mytricare.com you can check the status daily and see when you're approved before they even get around to mailing out the letter. As for a place to fax from, if you live in an apartment many will let you use their fax machine, especially for an 800 number or a local number. Also, any copy shop (Kinkos, etc.) and often even gas stations have fax service. There's also those mail places they usually have faxes for customer use. Liz

Good tips, Thanks Liz!

Hey Kirsten, I am so sorry to hear about your denial. I know the sinking feeling of hearing those words..."You've been denied." Take a deep breath and regroup, as others before me said, if you want this (and you do) then fight for it. These insurance companies don't want to dish out the bucks to do the surgery and if only they would realize in the long run they would be saving themselves money....I really don't know what they are thinking. The first thing I would would say to anyone that's coming into this for the first time........BE PATIENT!!! I was under the misunderstanding that my journey would be quick. It just don't work that way for some of us. I had no idea that my insurance would require me to do this 6 month diet before the approval. I went through 2 denials before that came into light. Kirsten, please try not to be discouraged and I know first hand exactly how hard that is. Only because I've been there. I know the cir****tances were different but nontheless it's still a denial. As I told you before I believe all and I mean ALL of us...even the skinny people have issues with emotional eating. Food means love & comfort and all of us want to feel those two things. My prayers are with you that your next exam will prove to be so different. I think it has a lot to do with whether the doctor you are seeing supports WLS or not. My former PCP was totally against the surgery. And she's morbidly obese also. Now my new PCP is all for it and she is a very small woman. All depends on their preception. Remember that all things are in God's hands and when the time is right for both you and me.........it will happen. Until then just do all that you can do to get ready for the journey of a lifetime. Lots of Love Kathy

Kathy, We keep missing each other! Thank you for being there for me! It is odd how different people support or do not support wls. My psychologist has no qualms about it! That's what's so ironic to me. My mental health came into question and the person who I went to for such is all for it. Her initial letter strongly recommended my having surgery. Then this happens. I, of course, am just paying the waiting game now! Tricare called and spoke with my husband today as he faxed my appeal letter from work. They said they were going to wait on making any decisions, until they received the report from my psych. She mailed it to me. So hopefully I'll get it tomorrow, and then i can fax it over to her. wait, wait, wait.....

Best wishes to you! Sounds like your paperwork will be in line with what the insurance wants now. Definitely, move that mountain! Kathy