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Three phone calls and more frustration!!!

Ok, turns out we had to wait a while for a letter of exclusion from my primary insurance before submitting to TriCare. That took till 8/26, then review of my file, then finally it was all faxed 8/28. Great, so I'm thinking...most of these people are getting answers from Tricare within a couple days so I was patient for a few days. Then I made the first phone call. "I don't see anything here" so I asked could they verify they received the fax and they did, then told me it usually takes 1-5 business days to process, so fine. I gave it a few more days and called again. :party: They tell me to call back the next day. That brings us to today... I called this morning,they said well it's here, call back around three. I called back and the person I talked to finally determined that they were holding it for the exclusion letter from my primary ins. And she determined THEY ALREADY HAD IT!!! The entire week went by and they had what they needed all along!!! So I'm SOOOO mad, and I have to wait over the three day weekend AGAIN.   At least it shows on Triwest.com as pending medical review. :tt1:   I'm so mad at all the delays...uuuuggghhh!!!!! And why did I think that just because I got every single thing they needed for all the doctors quickly that this would be fast and simple??? What makes me madder is my deductible starts over again on October 1st so if I can't get it done before then I get to pay my deductible all over again!!! CRAPPPP!! And my surgeon is a non-network provider so who knows how much is going to come from my pocket. I just want to get done worrying about all of this and get on with losing weight. Fingers crossed till tuesday or weds. :mad:
hope2bthinr

hope2bthinr

5
 

Been a long time...

Well, it's been a long time since I posted here. And I have to say, I never thought I would be following exactly the same story as so many on the different posts. The first few months I was ok, patient with the process but also impatient to get the weight off. Ate a few things I shouldn't have. Tried more than once to eat a food that wouldn't go down just to prove to my brain that it was a "no go". Worried this would be another attempt and failure when I hit the first plateau.   It did move slowly but surely, in small spurts. Then I got to a plateau and stayed there a couple months, and I was hoping and praying I hadn't wasted all that effort only to lose 20lbs. But once while I was in the plateau I thought, well if the lbs aren't moving but I'm feeling smaller, why don't I take some measurements? Well, I had lost 4 1/2 inches JUST FROM MY WAIST!!!! And an inch off each thigh!! I couldn't believe it! That was the encouragement I needed at the time.   I've gotten a total of 5 fills so far. The last one was very small but effective. Some days are easier than others and I feel sometimes like I work for each pound that comes off. But I am down 42lbs so far and can't even believe it because it's been so long since I've been here!   I've been walking 3 miles 3 times a week, bootcamp 2 days a week, on the odd weekend I might wake up early and add another day of walking, kettlebell work out or wii fit. One day the bootcamp had us carry 35lb kettlebells to work out with about 1/4 mile to the park. I was so tired after carrying it that far but I was thinking, "My god, I was carrying more than that much around on my poor body. NO WONDER I felt so bad!!" That thing was so heavy! Anyway, the alternating vigorous workout and moderate workout is working to get the lbs moving and I look forward to the workouts more and more and have to talk myself into it less and less. I'm getting there.   I'm so happy I did this. I am still learning I've got to take small bites or suffer the consequences, eat slowly, give each bite the time to work it out before taking another. I've been successful at quitting soda, caffeine, sweets, most carbs most of the time. I have learned that ground turkey or chicken in lettuce wraps are very tasty and satisfying and can be found at many restaurants. (I even make my own version of it at home.) Eggbeaters can be satisfying for breakfast, a breadstick really can be enough bread for a day. Cooking a big bunch of protein food for lunches is easier than trying to find a variety of places to eat where there is actually something healthy to order off the menu. I try to vary my food choices and add green veggies when possible. Grilled aparagus is so yummy. I can't imagine I would have said any of these things prior to having this surgery so I am thankful it has helped me to make a lot of changes that have been good for my health, mind, and the shape of my body. The brain is still taking a while to keep up with the food and body changes, but I actually had a dream that I was looking down at my body and it was healthy and at a healthy weight and looked awesome so I figure my subconcious is finally getting with the program and letting me know. I am THRILLED with the progress I've made so far, even if it's slower than some.   A footnote here...I was covered by Tricare Standard for the surgery which was done in Oct 09, and they just finally settled with the hospital (6 months later) after sending it back denied 6 times for some nitpicking detail. My cost out of pocket is just over $800 and only because a surgical assistant was used that didn't have what Tricare considered the "right" credentials to perform the assistant duties for the surgery. When you schedule your surgery, make sure the Dr takes Tricare and is a Network Provider and gets preauthorization. Make sure the assistant they use is approved and preauthorized and accepts Tricare, ditto with the anesthesiologist, and same with the hospital. Each of these participants must be approved, preauthorized separately and preferably in Network or you may be stuck with more of the bill than you expected and it's up to you to ask each of them the questions and verify with Tricare that they actually are approved, Network providers, preauthorized, etc. NO ONE WILL HELP YOU WITH THAT. Then, it is up to each of those participants to file all the correct paperwork with all the exact coding to ensure they get the claim paid (I made a lot of phonecalls when I started to get nervous that the bill wasn't going to be covered). I guess the moral of the story is, if you make sure all of the participants have worked with Tricare enough to know and comply with all of their requirements, you hopefully won't spend 6 months wondering if you'll get stuck with a $43,000 hospital bill and all the dr, anesthesiologist, surgical assistant bills. I'm just so glad the claims were finally paid. Thank you Tricare!   THANK YOU MOST OF ALL, DR. SARAH J LEE FOR CHANGING MY LIFE!!
hope2bthinr

hope2bthinr

5
 

Tricare-Expedited Resubmit my $#@@#!

I don't understand Tricare at all, and I now meet any definition they can come up with for the 200% of ideal body weight. I have had Tricare available and never used it for the last twenty years because I just used my other insurance and now that I ask for one benefit to be paid....I'm just so darn frustrated with this whole process!!! BUT I AM NOT GIVING UP!!!
hope2bthinr

hope2bthinr

4
 

My consultation day is finally arriving!!! TOMORROW!!

:w00t: I'm SOOO excited! Tomorrow is my conultation day!!! I think I'm on the edge of the 100lb overweight mark req. by Tricare, with a couple co-morbs, also required. I'm keeping fingers crossed, toes and everything else crossed. I'm determined this is the tool I need. Two things I'm worried about is whether they will approve the surgeon I was referred to and then, will the office staff submit everything just the way it must be to meet approval by Tricare quickly. If anyone has the magic formula for submitting to Tricare nowadays for smooth approval, please, please, reveal what it is!!? I've sent in all my releases, medical history, weight history for 5 yrs, weight loss attempts history for last 12 years, and I have documented asthma, stress incontinence, sleep apnea, high cholesterol, back/hip pain treated ongoing for 10 years, GERD, family history of heart problems and diabetes, BMI 42. My prelim blood labs are done, sleep test and Md referral. Attended an info session, attended a support session (req. by surgeon). Can anyone tell me if I'm missing anything?? Thanks!!
hope2bthinr

hope2bthinr

4
 

One More Step Closer!! YEAY!!

:wink2: I had my consultation with the surgeon today and it went very well. I'm a good candidate, have the qualifying stats & co morbid conditions, I shrunk an inch :w00t: oops! and came out with the weight required to qualify under my insurance (thank you lord, I can quit trying to keep my weight up). Of course I have to wait for the insurance approval, but each step matters.   Must get couple addt'l tests by my PCP, then all that's left is the psych and dietician. I feel so focused on this process.....but I'm absolutely sure I need to do this and don't want anything to get in the way. Good thing I have this blog to write in or I'd drive my hubby crazy with the details and my building excitement.   I'm very happy with how the appointment went today, I like the surgeon, she was very patient and informative, spent an hour with me and I feel confident she will do a good job.   WOOHOO!!! one more step closer. YESSSSS!!
hope2bthinr

hope2bthinr

4
 

I'm on the other side finally!!

I'm two days out from surgery and although I am sore (which I expect), I feel good mostly, just a little tired after taking the pain meds. Trying to get the liquids in is a challenge. I feel like right now I'm focussed on drinking, drinking, drinking. I drank about 88oz before but trying to get in 64 oz now is diffcult. I get that full feeling and know I have to stop until I feel the fluid make it down to the lower part of the stomach. I had a couple bouts with nausea the first day and evening, but none since. They seemed to happen just when I finished walking. I think I'm past it now as I haven't had that feeling since day one.   I've only taken the pain med once so far today so that's an improvement. Anyway, I'm happy to be on the other side of being banded and moving on with the whole process.   Big WOOT!! to Dr. Sarah Lee in Tucson/Oro Valley, AZ. and her terrific staff.
hope2bthinr

hope2bthinr

3
 

Sleep study DONE and results are....good?

Well, yesterday was a good day, I think!! In terms of getting to insurance approval at least... My dr. office called and said my sleep study results show I stop breathing or slow down enough that my oxygen level drops at night but it's not obstructive sleep apnea. But when I look at my ins requirements, it looks like if the Dr diagnosis is some kind of sleep apnea, it will qualify me. The Dr prescribed oxygen for night time, which seems drastic but it's better than having a CPAP machine from what I've heard. And maybe it will prevent me from falling asleep at my desk a couple times a day. :thumbup: SO, since it looked like I may have a good chance for preauthorization, I faxed all of my releases, health history, family history, weightloss history, insurance cards, everything I could think of over to my surgeon. Now, mind you, my appointment isn't until 6/2/09, so I'm thinking the surgeon is either going to think I'm very thorough or obsessive!!!!   All I know is, if this thing gets approved, and believe me, I will do everything in my power to make it happen, I want to move ON. I just want to get going. I'm finding myself without a lot of people to talk to about this because I've only told a few very supportive friends who will not spill the beans, so I may be posting a lot!!! I don't want to wear my friends out talking about this or with my excitement. So this is a good place to put it all down. Thanks for all the people that post encouragement here. I may not have pursued this if I hadn't read about 2000 posts worth of it.... So happy there is a place to write and to document my journey.
hope2bthinr

hope2bthinr

3
 

Only waiting for authorization!!!

Finally! My paperwork is being submitted to TriCare (my ins) for authorization!!! I don't know what took so long but I'm trying to be patient. First they were waiting for my echocardiogram and EGD results, then I found out only one year of records, not 5 years made it from my primary dr. to the surgeon...now they have everything and will submit! I can't wait! Here I was checking the Tricare site twice a day (like an obsessive) to see if the authorization came through and kept coming up empty. More phone calls, to primary, who says they sent the stuff, then call surgeons office, but in the end, it is all there and complete, reviewed and going to be on its way.   Anyway, I've been trying to keep busy at work so I wouldn't become a total pain in the butt. And that worked but now I want an answer!!! Keeping my fingers crossed to get an answer in the next couple days....
hope2bthinr

hope2bthinr

3
 

I Feel Great!

It's 12 days since surgery and I feel great. My bandages were off after 9 days and my cuts just look like small scars, except for the port cut. I didn't have the horrible gas pains most banded people talk about but I did walk,walk, walk from the first day and I know that must have been part of it. Anyway, I feel really good but really ready for the liquid stage to be over. I'm anxious for some chewablefood.
hope2bthinr

hope2bthinr

3
 

Tricare approved!!! YEEaayy!

I checked the website today on a whim and found that my authorization is finally approved!!! I'm SO EXCITED!!!:thumbup::thumbup::hurray::crying::hurray::thumbup:
hope2bthinr

hope2bthinr

3
 

One more appointment to go!!

I had my echocardiogram yesterday. THAT was a relief! I had taken Fen-Phen for about 18 months back when that was supposed to be the magic help for weight loss, so I was glad to know my heart is in very good condition, no valve problems, no indicators of disease. Woohoo!! If you knew about all the heart problems that run in my family....   SOOOooo, thursday is my last test required before insurance will give authorization IF they will approve. :thumbup: I willwrite again thursday after the test...
hope2bthinr

hope2bthinr

3
 

Once again...Tricare

Lucky me, my surgeon's office called and asked if I wanted to come re-weigh in since it's been almost three months since the official weigh in, and if I meet or exceed the required lbs they will resubmit. BINGO!! They're resubmitting!!! It's a darn good thing I didn't start dieting before finding out if the authorization was granted. I needed every pound and then some!!   Must update the ticker!! Still haven't figured out how to make it appear with the link to the ticker factory site intact... oh well.
hope2bthinr

hope2bthinr

3
 

When all else fails....try, try again!

After turning about 32, I started gaining weight and of course, trying to lose weight. The more I tried to lose and was successful, the more I'd end up gaining back every single time, and failing. It seems like a lifetime ago that I was actually at a reasonable weight or size. Back "then" I was very active, full of energy and felt full of life. I really want that back. It really, really burns me when friends say "well, maybe you just have to accept the way you are and live with it". Sure, all of those people haven't been down this road so it's easy for them to say that and I know they're just trying to be good friends. The trouble with that is, I'M NOT REALLY LIVING, PERIOD!!! There are so many things I just accept that I can't do while carrying around an extra hundred pounds. Even mopping the floor or vacuuming causes my back to be in pain to the point that I take preventative medicine before starting a task and sit down with ice on my back afterward so that in the morning after I can get out of the bed again. How is that living? But here I am...and this is going to be a new chapter and I'm going to write it different...better... and I know that with this new tool, I can be successful. Maybe not overnight, but what's two or three years when 18 have gone by in a blink and through that 18 years all I did was gain after every attempt and end up here? This time will be different. A year from now I'll read this, I know, and think "who was that depressed person??" So here I go!!! And I can't wait!!
hope2bthinr

hope2bthinr

3
 

Surgery Day is finally here!!!

I go in early tomorow for surgery at 9:00am. I doubt I'll sleep much tonight. The whole prep thing has my stomach complaining. Well, it better get used to it for a while!! LOL!! Bandster hell before the band!! I'm so excited I can hardly stand it.:wink2:
hope2bthinr

hope2bthinr

2
 

Dysfunctional Family Reunion

Ok, I just have to vent for a while because I'm eating like there's no tomorrow, and although I KNOW exactly why, that doesn't help. So I'm getting it off my chest. I had a family reunion over the Memorial Day weekend. I loved seeing all of my relatives I haven't seen in years. But here's the kicker...I have a sister who is the drama queen and charity case of the fam off and on for the last 30 years. Because right now she's out of work and didn't have the money, I made sure she had a plane ticket to get to the reunion, for my mom's sake. You would think that would be a good thing...my mom got all of her kids in one place for her 80th birthday wish, great! Well, this sister seems to think everyone is responsible for all the drama in her life but herself. It seemed as if the whole thing was in her mind "the drama queen episode" instead of mom's birthday/reunion.   So the drama was ramped up, and long story made short, I got to be the referee and psychologist for the week we visited my mother and family. It got to the point that the ranting, threats, raving and fit throwing hit a peak one of the days we were on this vacation and on the way to visit a cousin, I finally stopped the car and left her off at a Starbucks just so I could go on and have a visit with my cousin without the manipulating drama. ....that day went better from that point on!!   I have a lot of siblings and half grew up in one corner of the country and half in another corner. The older ones have this thing they do when they see each other (which I don't get, but whatever) they say, "IT'S ABOUT TIME!!" That's not even funny in my book but I don't let it bother me. Not so with the drama queen. It takes such a small comment to just turn a fine time into a big hairy confrontation. I'm not even kidding. Picture a 50 year old that stomps around, slamming doors, smoking doubletime (because nicotine is so calming dontcha know), ranting and raving, and generally acting like a 5 year old because one little comment set them off.   I just have to say, I was never so happy to drop someone off at their house when we got back to our hometown. I imagine I left skid marks!!!   I've decided that after all this time of helping financially, listening to all the "woe is me, why does all this crap always happen to me??" for thirty years, I'm done. Unless there is strong medication and a whole bunch of therapy, I will not be going on vacation with my sister again. I realized that there is absolutely nothing that will make her happy. I'm tired of being tromped on when the only thing I've done is try to help.   I'm going to try to be a little bit selfish and take care of me going forward. I'm going to try to get my stress eating under control. I guess I've gotten to the weight I'm at by emotional eating. I'm sure I'll be learning some new coping skills....and I still have my fingers crossed that my insurance will approve me for the biggest part of taking care of me!! My surgeon consult is on Tuesday!! It's finally near. So I'm putting the stress behind me. And I'm looking forward to my new beginning.
hope2bthinr

hope2bthinr

2
 

Got a Date!!

Ok, just a surgery date (19th Oct)....but I'm thrilled!!! I can't believe it's actually going to happen!! I go to my preop appt today. OMG, OMG, OMG!!! My closest friends and hubby are the only people I've told, and they are so supportive and excited for me. I'm so lucky to have those friends and my loving husband.   Not really related but the weather has finally shifted here and if it stays this nice we are going to have a great fall/winter/spring (all three kind of blend) and the lower temps will make it much easier to recover and get active again, quickly. I'd sure like to see some changing leaves on something other than a cactus! Will have to take some weekend jaunts to find the trees changing.
hope2bthinr

hope2bthinr

1
 

Tricare did/did NOT approve!!

Just have to rant and rave here for a few...Friday my surgeon's office called Tricare and was told I didn't need pre-auth because I had other primary ins so they are moving ahead as if it's ok :thumbup: and even set a surgery date (they even got a pre-auth #)... but then the Tricare website today says NOT APPROVED (WTH?? ) so when I called to find out why and what was going on, I was told I did not meet the criteria for the surgery being medically necessary. :cool: Either the 100lb over ideal weight + 1 comorbidity or >200% of ideal weight ( I met this one at 5'1" 226 and small frame). And of course I find this out right before 4PM so the doctor's office is closed. So I can't have them call today to find out what went wrong. :thumbdown:   Anyway, I'm still trying not to get upset, that there must be a mistake somewhere and hopefully it will get straightened out in the morning. :sad: :scared2: :crying: :ohmy:   ....I really want to have happy news in the morning!!
hope2bthinr

hope2bthinr

1
 

Getting closer....still waiting....

One month has passed since my last post, and I've calmed down and regrouped, I have my last two appointments this week. Once I get those over with my doctor should be able to submit the paperwork. It seems opposite of what is usually done but maybe it's because there are two insurances to go through. one won't pay for the band but will pay for tests and consults. Whatever, I will go with the flow... can't wait for the week to be over!!:confused:
hope2bthinr

hope2bthinr

1
 

Come ON already!!! Pre-op frustration!

Ok, so today my PCM saw me as a follow up appointment, and they've had my consult information from the surgeon for a week already and was just reading it while I was sitting there!! So finally they are going to send the letter of medical necessity to the surgeon so the surgeon can request the preauth from insurance. Okay, all well and good, but the surgeon won't request preauth without a Echocardiogram and an EGD WHICH CAN'T GET SCHEDULED ANY EARLIER THAN A MONTH FROM NOW!!! :thumbup: And that's only because of which gastro the PCM decided to refer it to!! :rolleyes2:   Now, there are at least 50 other gastros on both my insurances in this town!! Surely it could get scheduled earlier through some other gastro!!! I mean this is the only hold up and I feel like I have been shoving a cart with square wheels up a darn mountain so far and this is just frustrating me to no end. Is it reasonable to request my PC physician refer to a different gastro for the EGD?? :rolleyes2: ....One that can see me sooner so I can finally find out if I'm even going to be approved?? I know other people have spent longer than this going through this process but I've done everything they've asked and more. And this isn't even waiting on insurance or even the surgeon, it's just waiting senselessly for a darn appt. They've never had to ask me for one more piece of info....that's how much I researched and prepared before even going to the surgeon. UUgghh! It's just such a tedious process. Ok, I'm done with my spoiled brat whining... but I am going to call my Dr back and try to see if they'll refer to another gastro. I don't know how I can make a whole month go by without pulling my hair out!! I could have had the Echo done tomorrow but it has to be within 2 wks of surgery, but if the gastro can't do the scope till a month from now, I'd have to get it done all over again. And I don't know why it should take a month to get a stupid appointment. You would think the dr. assistant should have looked for some other one to send me to when I'm only waiting for this to get done with everything I had to do before surgery.   Thanks for reading and letting me rant here!!
hope2bthinr

hope2bthinr

1
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