Question:
need an appeal letter to use for a denied reconstruction surgery

TriCare Prime denied me my recontruction plastics surgery. They paid for the 1st consult and the 2 opinion. Just wanted the TT & and Breast lift....need an appeal letter to help change their minds.....thanks alot guys and gals....    — Janet M. (posted on October 2, 2004)

October 2, 2004
I have one i will mail to You This is from a girl who got ALL that good stuff covered. Her profile tells more detailed info of what to do and expect She is a wiz I hear with the ins comp's. SO best wishes Shell
   — Shell G

October 2, 2004
Hi Janet. Before sending out an appeal, find out why you were denied. Your PS should have a game plan to meet whatever requirements the plan has. Many plans only allow one internal and one third-party appeal, so use this option wisely, be prepared, and have your "ducks in a row" as much as possible.
   — DrL

October 3, 2004
Janet, I,too, have Tricare Prime (west region). Tricare did pay for my consultation and is paying for my follow-up visits. As for the reconstructive surgery, Tricare covered my abdominalplasty, but I had to self pay for my breast lift, arms and thighs. I also know that in order for them to cover an abdominalplasty, you must have medical documentation to verify that other problems exist because of the panni, ie; lower back pain, rashes, etc. You do realize that Tricare has just recently changed insurance companies, therefore, you might need to do some research as to the new policy coverages. Good Luck. Kathy C
   — Kathy C.