SYRREHS

I've been having hot flashes for a few years now and have been taking black cohosh and it was helping, but come this last April bam they got more intense. I talked with my Gyn doctor and she suggested to me a low dose estrogen and progesterone. I started them and within 2 weeks I gained 8 lbs. and I felt it. There was no change with the hot flashes either. I stopped the hormone therapy. I found Estroven, it's a vitamin and herbal mixture and it seems to be helping and I've been using it for 5 days now. Now I just need to get this 8 lbs. back off. I have an appt. for my 5th fill in 10 days and can just imagine what the doc will think.

I bet the diet pills helped out and that you were going through a doctor for them. I did mine without a doctor. This is a very helpful way to find out what needs to be done and correctly to help get an approval. Thank you..... Please let me know how things are going for you and if you ever need anyone to talk with I'm here... 8 ] I'm going to call my doctor's office tomorrow to see if he signed the papers for me to start the Lighten Up program and I can get started and hopefully find out soon if they (TriCare) needs 3 or 6 months for the medical treatment. I just want to get it completed and hope and pray that that is all TriCare needs and won't change their mind and add something else. Have a Super Day......

I agree about all those programs being so expensive.... it's crazy..... I can't get over that so called doctor laughed.... report him or her and maybe they will get written up or sent to Siberia.... I spoke with the nurse at the surgeon's office and she suggests (just her own opinion from seeing what others have gone through) that instead of filing an appeal to try going through the Lighten Up program that the hospital provides, she was submitting the papers for the doctor to sign for it, so I hope he does.... I still can't get a duration time that TriCare needs to approve me and that was speaking to someone at TriCare too. (Go figure)

I was able to find this on the TriCare.mil site but, I still can not find where they have the duration for the non-surgical medical treatment i.e. Weight Watchers, Jenny Craig or doctor's program. Has anyone seen this on the website? I have also seen the change since I last checked (in which was just a few days ago) that the word, "all" is listed instead of "or" and it's underlined...... FAQ HomeNew Search Frequently Asked QuestionsDate of Last Update: 10/11/2011 9:23:24 AMDoes TRICARE cover bariatric surgery to treat morbid obesity? Yes, TRICARE covers bariatric surgery if you meet all of the following conditions: You're at least 18 years old or you provide documentation of completion of bone growth. You were unsuccessful with non-surgical medical treatments for obesity. Your medical records must show your failed attempts.Diet programs, such as Weight Watchers®* and Jenny Craig*, are acceptable methods of dietary management, as long as there's medical documentation of participation and monthly clinical visits with your doctor. *These programs aren't covered by TRICARE. Physician-supervised programs made-up of only weight-loss medication management, don't meet this requirement. [*]You have proof of one of the following: A body-mass index greater than or equal to 40 kilograms per meter squared (kg/m2); or A body-mass index of 35-39.9 kg/m2 with one clinically significant comorbidity, including but not limited to, cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, Pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy, or pulmonary hypertension. http://www.tricare.mil is the official web site of the TRICARE Management Activity a component of the Military Health System Skyline 5, Suite 810, 5111 Leesburg Pike, Falls Church, VA 22041-3206

So I've been going through the steps with my doctor for the surgery and I too have TriCare Prime.... I've had the dietitian evaluation, the phycological evaluation, medical clearance from primary doctor, met with the surgeon twice and last week they submitted the papers for approval. Well within a few days the authorization was denied... saying not medically necessary.... So I call TriCare asking why????? I said to the customer service agent, "Why would my doctor submit for the precedure if he didn't feel it to be medically necessary?" Also, I asked was there another reason and she said because there was no record of me having any medical treatment such as; Weight Watchers, Jenny Craig and so forth. So I let her know that I have not gone through those programs because I can not afford them for they are very expensive. I've tried Slim Fast, patches, Dexatrim, Acai Berry, counting calories, food log and so forth. I also said that the website for TriCare does not state the medical weight loss programs as a requirement. It says; 100 lbs. over ideal weight and atleast one associated condition; such as high blood pressure (in which I have).... Is 200 % or more over ideal weight or Has had intestinal bypass or other surgery for obesity. In another area regarding Bariatric surgery it says the Lap Band is a covered benefit that requires prior authorization and medical necessity review. Pre-surgical psychological evaluation and testing is covered. Pre-surgical nutritional counseling should be performed by staff in the provider's office and is not covered if requested separately. No mention of medical weight loss programs.... All she could say after that is that I can appeal the denial and that she can not see what a beneficiary sees on their side of the computer system.... GGRRRRR I put a call into my doctor (surgeon) to find out if they have come across this before. I left a message and I'm awaiting a reply. I know I'm going on and on but this is driving crazy..... Has anyone heard of this requirement for TriCare?