Question:
Anyone delt with Tricare Standard on an appeal?

I was just denied surgery by Tricare (Standard) I got my non-availablity without a problem, but they said no to the surgery. The letter stated that my sleep study showed that I have snoring problem, not apnea. My sleep study, which I have had 1 more since, clearly states that I have obstructional apnea, I stopped breathing with the cpap. I am 100# over, but my BMI is 37. My surgery was supposed to be on Monday June 3rd, but I guess that's not going to happen. Any advice would be greatly appreciated. Colleen [email protected]    — Colleen R. (posted on May 29, 2002)

May 29, 2002
Why don't you switch to Tricare Prime? I used to have Tricare Standard and my $460 dollar a year family premiums now with Tricare Prime are so MUCH lower than what any 20% I'd be out with tricare standard, especially with this surgery. Also, Tricare Prime is easier to get approved :-) Good luck.
   — Tina P.

May 29, 2002
Tricare is very strict about their conditions. You have to be at least 200% of your ideal body weight with no comorbidities or 100lbs over your ideal body weight with one of I think five comorbidities. You will need to check your manual or do a search on their website. They are named there. They normally do not make acceptions. Tricare Prime has the same coverage as standard, so that won't help you. But you will pay NOTHING with Prime and you have all the deductibles and such with Standard. Good Luck!
   — Virginia N.

May 29, 2002
Colleen, I see you are from Virginia Beach. I had my surgery at Portsmouth Naval and they are superb!! In fact, Dr. Spencer was the first to perform the gastric bypass laproscopically in the state of Virginia. He travels worldwide to train other physicians in this procedure. You will have the most excellent care! His whole team is fantastic, they always act excited to see me and wow'ed by the results. They truly have a passion for their work. And I cannot say enough about the after care. They do follow-up appointments and bloodwork much more often than the civilian doctors. The surgeons, bariatric case manager, nutritionist and their RN attend each support group meeting. The nutritionist also has an open door for 1 1/2 hours before the meeting each month where we go for weigh ins, nutri advice and more labs can be ordered if necessary. They really keep a close eye on us. And another 'perk', I didn't have to pay a dime in costs. As you can tell, I have been very pleased. If you have any other questions, I would be more than happy to talk about it. Please email me at [email protected]. If you want to stay with your surgeon, I hope everything works out for you.
   — Cheri M.