Pashion
-
Content Count
118 -
Joined
-
Last visited
Everything posted by Pashion
-
Is my postop pain normal??
Pashion replied to formykids2's topic in POST-Operation Weight Loss Surgery Q&A
I am sorry to read that you are in so much pain, maybe if it continues you should call the surgeon. I will pray that the pain subsides quickly for you. Good Luck -
I am happy to hear you have been banded. Still waiting for my approval. But I wanted to know where did you buy you Pure Protein. The only thing I have tried is Muscle Milk Likght and only the vanilla taste good to me, but I am picky like that. Good Luck
-
Newbie in Dallas, TX
Pashion replied to HeatherChelle's topic in Tell Your Weight Loss Surgery Story
Wow Heather that is great!!! My paperwork was submitted yesterday for approval so now I am just gonna sit back and see what happens. How do you feel? Are you hungry? Did you have it done at a hospital or at a weight loss center? What did you have to do to get your insurance to approve you? Good Luck Nikia -
Hello All, I am new to this forum and I have questions regarding getting approval for the Lap Band by Tricare Prime and I am hoping that someone out there can give me some insite on this because I am starting to get discouraged. My first question is I was told by the nutritionist that because my BMI is 38.6 Tricare will prob deny me. But I thought that as of 03/16/2011 Tricare Prime was approving the lap band if your BMI is 35-40 with one co-morbit. Has anyone with a BMI under 40 been approved by Tricare Prime? My other question is the insurance coordinator at the surgeons office stated that Tricare is the hardest insurance to get approval from and that there is a chance that Tricare will approve me but only if I go to a local MTF for the surgery she explained that this has happened to other Tricare patients in the past. My local MTF is Balboa hospital and I would prefer not to go the there if I didn't have to. Has anyone been approved by Tricare but only if they go to a MTF for the surgery and not to a civilian hospital?
-
Hello Dave, WOW!!! you were approved quickly...I have called Tricare Prime four times and under the new rules you can have a BMI of 35-39 with one co-morbid but now they also require documentation from your PCM stating that you have tried other weight loss programs or meds that did not work. The surgeon has to write up the request stating that this procedure is for health reasons and not for weight loss (how crazy is that) and that nothing else in the pass has worked. What I thought was strange is that there is nothing in Tricare's policy that says how many months of proof they are requiring and they never mention anything about blood work or having to have an endoscopy done. Why is that I wonder? How did you know that lab work and an endoscopy was needed? Like I said I have called Tricare four times and not once has any Tricare rep mentioned that to me. I wonder if I will be denied stating that I need to have these procedures done first. One other thing I almost forgot to mention. According to Tricare if there is a surgeon at the MTF that is available when the request is submitted and surgery can be done within 30 days Tricare will request that I go to the MTF. They stated that is with any type of procedure because Tricare is military they will always refer to MTF first if possible. Was you BMI over 40?
-
Thank you. When is your surgery date? Did you need to submit proof that you have tried other weight loss procedures and nothing worked? What reasons did they give you for your previous denials? I am currently waiting for my previous doctor to send my medical records to the surgeon showing my co-morbit then they will sumit it to Tricare Prime for approval. I am currently at 38.6 BMI but my previous doctor was not very attentive so I had to switch to a new doctor who I have only seen twice since Sept. she does not have as much medical history on me as my previous doctor. Some people who have Tricare Prime had to have blood test and and a endoscopy done before Tricare would approve it, did you?
-
Your message was very helpful thank you so much and good luck with your surgery, I know you will be successful.
-
I have done my consult with the surgeon and the psych eval, now I am just waiting for orientation on the 17th of this month and a diet class these are required by the surgeon not Tricare. What type of documented trail do I need to have? This is exactly what I am talking about, I called Tricare three times and nobody said anything about having an h pylori, pulmonology or cardiac clearance done. What is h pylori? They did mention having documented weight loss but could not specify what type of weight loss documentation they are looking for and when I asked for how many months they could not tell me that either.
-
Thank you so much for responding back, sometimes it gets discouraging when you tell people you have Tricare and they look at you as if you are from out of space. Do you know if Tricare will require me go to the MTF instead of my civilian hosptial to have the surgery done. Are you using a MTF or civilian hospital?
-
Ticare Prime MTF vs Civilian hospital
Pashion posted a topic in PRE-Operation Weight Loss Surgery Q&A
Hello All, I am currently two appts away from my paperwork being submitted to Tricare Prime for approval of the lap band. A couple of days ago I was told by the insurance coordinator at the surgeons office (civilian) that Tricare is the hardest insurance company to get approval from and that Tricare has been known to approve the surgery only if the patient has it done at there local MTF. Has this ever happened to anyone? If so please advise? I am here in San Diego and my local MTF is Balboa hospital and they do not have a good reputation so I would prefer not to go there if I do not have to. Thank you -
Tricare Prime - Lap Band Denied Again, Again, And Again!
Pashion replied to AZArmyWife36's topic in PRE-Operation Weight Loss Surgery Q&A
I am glad that you have been approved because I have the same situation my BMI is 38.6 and the nutritionist told me that I would prob be denied because I have to have a BMI of 40 + one co-morbit, but now I see that is not true. One other thing I was also told by the insurance coordinator at the surgeons office that because they are civilian there is a chance that Tricare might come back and say that they will only approval the surgery if I go to my local MTF to have it done. Do you or anyone else reading this knows anything about this? -
I have a two part question. I have Tricare Prime (west) and is located in San Diego, CA...My husband is retired Navy and I am skeptical of the local MTF here in San Diego (Balboa) so I chose a civilian PCM. I am 5'3 and currently weight 223lbs and have one co-morbit which is sleep apnea I do have a CPAP. I was referred to the surgeon and my first visit was on Sept 20, 2011 and he stated that I am a good canidate for the lap band but Tricare is a hard insurance to get approval through. I did my pysch eval on Oct 5, 2011 and my nutritionist visit on Oct 7, 2011 now I am just waiting for the orientation which is on the 17th of Oct and a diet class that is required by the surgeon on the 24th of Oct. Then I guess everything will be submitted to Tricare for approval...Okay, now my questions are: Because my BMI is 38.9 the nutritionist said I will prob not be approved. But I know that as of 03/16/2011 as long as you have a BMI of 35 or higher and one co-morbit I should qualify. Has anyone else been approved with a BMI under 40? Also the insurance coordinator at the surgeons office stated that there is a chance that Tricare will come back and say that I have to have the surgery done at the local MTF because that has happened to other Tricare patients of theirs before. Has this happened to anyone? Please let me know because I am starting to get discouraged.
-