MrsMoretti

Hi everyone I have tricare prime west region iv been through the whole process already once before and i got denied this was before they just changed there policy as of 10-5-11 where now they arnt using the 100lb over weight or 200% rule.... they are now going by a bmi of 40 + without a co morb or 35-39.9 with a co morb ..... I am about a 40 with no DOCUMENTED co morbs but I also have heard now they are making you do a medically documented weightloss program weight watchers or jenny craig etc. I heard it was a 6 month program that had to be documented but when i looked in there policy they dont state a time frame or 3 or 6 months .... im just curious if anyone has been approved without having to do this 6 month diet program .... i have documents from my dr. stating i did weight watchers with no sucess but also it wasnt for 6 months maybe 3 or 4..... so just curious is any of you have been where im at and if u still got approved I got to my see my surgery dr tomorrow for my last final weigh in before they can submit my paperwork again im really hoping to get approved ..... please please please let me know people..... thanks : ) wish me luck shayna

So I need to know what foods to eat before and after surgery and how long are each of the phases like liquids,mushies,and when can u move to solids? Anyone please help

The people who look sick eat shitty food .... Eat healthy and take Vitimins and ur fine ; )

I just went through this whole process 3 times and got denied by them finally round 3 I appealed my case and got approved .... I fought this denial because I met all the guidelines and in there policy it does not state u need 6 months they just try to tell u that over the phone but for this to be in affect it has to be in writing in there policy ... That's why I fought it and won because they tried to tell me I needed 6 months of failed weightloss attempts .... But they couldn't prove that cuz its not in the policy ... I think you have a good shot , if they deny you appeal it and mention what I said in ur letter ... Hope this helped ....

they now have changed there policy which is soooooo annoying because no where on there website does it say that u need 6 months of documented weight loss attemps recorded by a dr.... it just says that you now need to have weight loss attemps recorded by a dr. no time frame is stated but when u call triwest on the phone they tell you there policy now is a 6 month documented weightloss attemps recorded by dr.... IM SO MAD!!!!! cant believe they can get away with this ! so its now a 40 BMI or a 35-39.9 with co morb PLUS 6 months of proof from a dr! good luck everyone im having a real hard time getting approved !!!!! 3 time around and still getting denied!

Not true they do require you to have a 6 month diet plan ... im going through it right now they just changed there policy as of 10-5-11 and it doesnt state it online but i just got in a huge fight with the b***h on the phone about how it is now 6 months of failed attemps of weight loss DOCUMENTED by a DR. in order to get approved plus you have to meet all the other quilifications! 40 BMI without a co- morb or 35 -39.9 with a co-morb.... good luck seems like im the only one thats been getting screwed around tho everyone else says tricares so easy to work with ! for me they havnt been its been hell!!!

im going thru it now and i am also worried about the 6 month thing they just changed there policy i guess to needing 6 months before you can have surgury ....

well maybe i have hope just got submitted today but tricare i guess just changed there policy stating that u need medically documented attempts for weight loss but it doesnt state that there has to be 6 months.... anyone know about this..?

do you know if they are really strict on the exact 6 months thing? because no where in there policy does it state 6 months it just says failed attemps of documented weight loss.... atleast for triwest

do you know if they are super strict on the 6 month thing what if you have proof of documented attemps but it doesnt state a time frame??

Hi everyone please help me.... did hear tri care just changed there policy and now make u do 6 months of documented weightloss with no results.... is this true anyone got approved without being on a 6 month program....??

greatttt!!

Hi Im going through the process and im just curious what they mena when they say 200% over ideal body weight for height and frame??? i looked on the metlife scale for med frame female and it says 127-141 so does that mean i need to weigh 241 is that 200 %???? if anyone knows pleassssssseeeee clarify this for me thanks!!!

I Have a question what exactly does 200% over ideal body weight mean??

Dr. Rendon is going to be by Dr. He is very nice and professional I like him if all goes well I should be getting surgery done by him June 6th 2011!! ill keep everyone posted .. Shayna

june 6th for me i cant flippin wait !!!

me to june 6th YAY

well wish me luck ..... they should be submitting my paperwork very soon

my bmi i think is like a 39.3 or something Im praying i dont have to appeal it because they deny me.... that would SUCK!!! if you do appeal it and u gain a few more pounds do you have to go through the process all over again??? like seeing all the DR'S?? please help if you know anything thanks.... shayna

Thanks ya i dont see you having any problems being approved... good luck

Hello Everyone, I have Tri Care Prime. This is what my journey so far has been like. I had to go to my PCM to get a referral to see a surgeon , So I got my referral I called to make an Apt with the surgeon and I found out that I had to attend a Free seminar first before I could schedule an Apt with the surgeon. So I went to the free Seminar and while I was there the bariatric coordinator told me that she was going to get the process started for me and she told me what I needed to do from there on out so what I had to do was make 3 Apts with other Dr.’s that Tri Care requires you to go to which were 1. See a Bariatric Dr. he basically just asks you about your history and your health 2. I met with a nutritionist basically she just ask me what my eating habits are and told me a little bit about how its going to change with the Lap Band DUHHH no kidding its going to change right ?? LOL ….. Thinks that’s why we are all looking to get the surgery because we need a change in our lifestyle 3. Was a Phyc Apt. Just making sure your really ready for this lifestyle change and making sure that you will be able to handle it. Then after all 3 Apts you schedule your Apt with your surgeon. I met with him he did some paper work told me that I am boarder line where im supposed to be for tri care to approve me I’m 5’5 235.6 when I got weighed in at his office. Going by what everyone else says that Tri Care uses the Met- Life weight chart (med frame) which says you should weigh 127-141 for my height So that should put me at 200% over my ideal weight Im PRAYING that I get approved …. So I’m all done with my appointments with Dr’s but I still need to attend a class where they tell you all about how your lifestyle and eating habits will change after surgery I heard that this class is mandatory in getting approved for surgery . So I will be attending that class May 10th 2011 , after that my bariatric coordinator is going to submit all my paper work to tri care and hope I get approved….. If anyone else is around the same height and weight as me and got approved or has a similar story and didn’t get approved please let me know. I also have a bad back and joint pain along with anxiety I don’t know if that will really help my case much, Please reply and give me any input you may have and I hope I was helpful for any of you who are just getting started in the process . Oh also Since I was boarder line where I was supposed to be my bariatric coordinator told me that I should get a support letter from my PCM saying that I have tried other weight loss diets and didn’t have success and that I have a bad back and anxiety and he thinks that by me having the surgery it will help with weight loss and will help with my back pain…. My bariatric coordinator told me that having a support letter it will only look better for you getting approved … I also had to get an EKG and chest X-ray done before my PCM would write the letter he wanted to make sure I was healthy enough for surgery ! …. So that’s all so far hope I helped maybe you all can help me and let me know what ur process was like Thanks

what ins do u have ?

Tricare Prime does not require you to do a 6 month program with dr. hope that helps

Hello Everyone, I have Tri Care Prime. This is what my journey so far has been like. I had to go to my PCM to get a referral to see a surgeon , So I got my referral I called to make an Apt with the surgeon and I found out that I had to attend a Free seminar first before I could schedule an Apt with the surgeon. So I went to the free Seminar and while I was there the bariatric coordinator told me that she was going to get the process started for me and she told me what I needed to do from there on out so what I had to do was make 3 Apts with other Dr.’s that Tri Care requires you to go to which were 1. See a Bariatric Dr. he basically just asks you about your history and your health 2. I met with a nutritionist basically she just ask me what my eating habits are and told me a little bit about how its going to change with the Lap Band DUHHH no kidding its going to change right ?? LOL ….. Thinks that’s why we are all looking to get the surgery because we need a change in our lifestyle 3. Was a Phyc Apt. Just making sure your really ready for this lifestyle change and making sure that you will be able to handle it. Then after all 3 Apts you schedule your Apt with your surgeon. I met with him he did some paper work told me that I am boarder line where im supposed to be for tri care to approve me I’m 5’5 235.6 when I got weighed in at his office. Going by what everyone else says that Tri Care uses the Met- Life weight chart (med frame) which says you should weigh 127-141 for my height So that should put me at 200% over my ideal weight Im PRAYING that I get approved …. So I’m all done with my appointments with Dr’s but I still need to attend a class where they tell you all about how your lifestyle and eating habits will change after surgery I heard that this class is mandatory in getting approved for surgery . So I will be attending that class May 10th 2011 , after that my bariatric coordinator is going to submit all my paper work to tri care and hope I get approved….. If anyone else is around the same height and weight as me and got approved or has a similar story and didn’t get approved please let me know. I also have a bad back and joint pain along with anxiety I don’t know if that will really help my case much, Please reply and give me any input you may have and I hope I was helpful for any of you who are just getting started in the process . Oh also Since I was boarder line where I was supposed to be my bariatric coordinator told me that I should get a support letter from my PCM saying that I have tried other weight loss diets and didn’t have success and that I have a bad back and anxiety and he thinks that by me having the surgery it will help with weight loss and will help with my back pain…. My bariatric coordinator told me that having a support letter it will only look better for you getting approved … I also had to get an EKG and chest X-ray done before my PCM would write the letter he wanted to make sure I was healthy enough for surgery ! …. So that’s all so far hope I helped maybe you all can help me and let me know what ur process was like Thanks

IGNOR THE LINKS I THINK THEY ARE SPAM THEY GOT ADDED WHEN I POSTED SORRY