Startingover!

Thank you to everyone! My surgery date is June 17th. It seems like a lifetime away! But I figure I've waited months to get approved so I can wait another month.

I am finally getting banded on June 3rd. I'm so excited!!

Not a problem! Good luck with Dr Larson. Keep me posted!

:smile2: I'm so excited, my surgery is scheduled for June 3rd. Does anyone have any advice? Thanks!

My doctor just resubmitted it. But I had to be 100lbs over their requirement before they would approve it, even with the co-morbs. It's bad to say but I purposely gained a few pounds for the approval. Otherwise I would have never been approved. Good luck to you!

You'll like Dr. Larson. The staff is really good there. Everyone has been very helpful and supportive. Good luck to you! BTW-I'm the Amy half of the steveamy! LOL

Ok people!! I am waiting on approval and now I'm wondering if the band really works after reading everyone's posts!! But at the same time I see the weight everyone has lost, so it probably does work!! Like other people here, I have a serious food addiction and a bottomless pit of a stomach and to top it off, no will power. So reading all of these posts about no restriction is not good. For all of those out there who have had one or more fills - Do you start feeling restriction eventually?? God I hope so!!

I was denied yesterday by Tri-Care. I'm so disappointed. Has anyone else out there been denied by Tri-Care and then approved on appeal? The doctor is of course appealing it, but I just don't think it's going to happen now. So I'm not getting my hopes up. :huh2:

I am exactly 99lbs overweight. I would hope they would over look the one pound! I have documented via MRI's arthritis in my knees and back. Have had 3 surgeries on my knees. I was tested for sleep apnea which was so mild it was almost negative, but they did request further testing. I have a very large hiatal hernia. Shortness of breath, various documented weight loss attempts by doctors. I've passed all the required psych tests, nutritional tests etc. I think there are a few more mild co-morbs. I actually just got off the phone with Tricare. They said that the when the doctor sent in the last updated clinicals they didn't send in a letter of appeal, so they are not processing it without that letter. But they said that I could send the letter. Which I just did and have received receipt that they received it. So maybe now the ball with start rolling!! Thank you for everyone's information. It is very, very helpful!

No, Tricare does not require a 6 month supervised diet. At least not to my knowledge.

This was the second time it was denied. The first time they wanted more information, a sleep study done etc. So we gave them the updated info and they denied it. So they wanted more info, so now we're waiting to hear back since we sent them even more info. Considering that you use to work there can you give us any insider advice?? LOL

Are you planning on appealing it? If so what is the status of yours? I'm waiting to hear back on the appeal. They told me to call back on May 6th. The waiting is killing me!! Good luck to you!

I'm waiting on approval from Tri-Care for my lapband and my PCM did a blood test I just got the results today and they are as follows: Red blood cell count Low 3.65. Hemoglobin Low 9.1. Hematocrit Low 28.2. MCV Low 77.4. MCH Low 24.9. RDW HIGH 15.1. Platelet Count High 407. DHEA Sulfate Low 28. Bun/Creatinine Ratio High 23. Folate Low 3.9. Sorry for all of the info!! But it's a little scary. It seems like everything is out of sync! Does anyone have any explanation? Before I had these results I completed a saliva (hormone test) last week, so before the doctor acts on these test she wants those results also. But she did give me a B12 shot and a prescription for Niferex until we get the other results back. Thank you in advance for taking the time to read all of this! Amy

Thank you so much for your response(s)! For the pre-op for lap band I just had an upper GI and endoscopic and there was no evidence of bleeding. But since those tests I have had minimal, almost not worth mentioning, blood in my stools. I have started vomiting at least once every couple of days in the past month. I don't know why. I guess I just I just worry because my mother had cancer and lupus to name a few problems. Corry- The doc gave me a prescription for an Iron supplement. So I'm hoping that will help. Good luck with your new band and Congrats! Thank you both for your help!

I got my letter of denial from Tricare yesterday. Very disappointed. I was wondering if anyone on here had ever appealed with Tricare and if so what was the outcome? Also, I have Tricare Prime, is Tricare Standard easier to get approved with? If it is I'll switch!! Thanks in advance for any info!

Thank you so much for the information. My doctor's office called them yesterday and spoke with a supervisor. They corrected the "not covered" issue and now they just want me to provide proof of one more comorbidity. They said arthritis in my weight bearing joints would be sufficient. So I tracked down some old MRI results that stated I had arthritis in my knee and lower back. So the doctor is sending those tomorrow. The supervisor has given the impression that with this additional information a approval will come. So we'll see. I'll definitely keep you posted. Thanks again for the info and advice.

I will let you know if I need to borrow your appeal letters as a guide. Thank you so much for the offer!

I called Tricare this morning and they said I was one comorbidity (spelling) short. They did however say that I needed to appeal it and in the appeal make sure the doctor notes, not documents, that I have arthritis in my knees and back. She led me to believe this would get it approved, but I'm still very hesitant about it! I then called the doctor and they had talked with Tricare yesterday about it and were told the reason it was denied was because Tricare doesn't cover it. Which is not true. So the doctor's office is first going to address that issue, if they don't get anywhere with that then we will appeal it with the words "arthritis" in the appeal. The letter of denial did say that it was not a covered procedure. It also said that it covered vertical banding, which I thought was the same thing as lap band. So not knowing this I called Tricare first. But after talking to my doctor's office they said that the denial is strictly because Tricare claims they don't cover it. I'm so confused! I guess I'll just wait to hear back from the doctor's office today after they talk to Tricare. I've read many things on here about the approval process and what a roller coaster ride it can be. I had no idea! It really wears you down. I only hope it's worth it in the long run.

Thanks for the link. Do you know what frame they go by or does the doctor tell them that? Congrats to you for your band!

The waiting for this is killing me!! Does anyone have a link to the Metropolitan weight charts that they go by? I lost the link and I just wanted to look at it again. I am trying not to get my hopes up, because I'm really afraid they will not approve it. I don't know what I will do if they don't. I guess I'll go back to Weight Watchers and try that, again.

Hi, I'm also in WPB. Did Dr. Larson do your band? I'm waiting on approval from Tri-Care for him to do it. I should find out within a week (I hope so!) I was just wondering if Dr Larson did yours what your experience was with him? Thanks!

I guess I jumped the gun. My doctor called Tricare today and the denial was on the first submittal, not on the latest one. They had wanted a little more info after the first one. Tricare said it is still in the pending state. So I'm keeping my fingers crossed but not getting my hopes up.

I wasn't aware that I could question them! Duh!! I'll have to do that when I get home from work. Thank you for the info!

I'm waiting to hear back from the doctor's office as to why they denied me. So I guess we'll go from there. It's just very depressing.

I have copied my sleep study report below. To me it doesn't look complete, but then again I've never seen one before! I was wondering if anyone could help me to understand this? Thanks in advance! SPLIT NIGHT POL YSOMNOGRAPHY POLYSOMNOGRAM TECHNICAL SUMMARY: This is a 16-channeI polysomnogran. Duration of the recordingis 363.0 min. .Four channels are used for EEG, two for oculog'am, and one each for chin EMG, nasal-oral airflow, chest respiratory effort, abdominal respiratory effort, ECG, oxygen saturations, body position, microphoie for snoring, and two for anterior tibialis muscle activity. Lights out at 11:29 PM andlights on at 5:32 AM. POLYSOMNOGRAM SUMMARY: Sleep architecture: Sleep efficiency is 85%. Sleep onset occurred at 10.5 minand REM onset began at 285.0 min. (4.8 hrs.). The patient spent 2% total sleep time inStage 1, 92% total sleep time in Stage 2,0% total sleep time in Stages 3/4, and 5% in Stage REM. Arousal rate is 13.0 per hour. Total sleep time is 310.0 min. (5.2 hrs.). Respiratory data; 0 obstructive apneas, 0 hypopneaSjO mixed apneas, 0 central apneas are noted. The average rate is 0.0 per hour (normal is less than 5). Supine rate is 0.0 per hour with a non-supine rate of 0.0 per hour. The non-REM rate was 0.0 per hour and the REM rate was 0.0 per hour. Minimum oxygen saturation with events is 0. Total supine time is 86.6 min. with anon-supine time of 222.8 min. (3.7 hrs.). Periodic Limb Movements in Sleep: PLMS rate is 0 per hour. PLMS arousal rate is 0 per hour. POLYSOMNOGRAM IMPRESSION: This overnight sleep study reveals the following fhdings: 1. Patient history (Get from the Sleep History Questionnaire) 2. A) The pqtient did not meet laboratory proJoCQlcriteria for initiationof nasal CPAP during the first two hours of the study. Upon completion of the study, the/patient dd qualify for a nasal CPAP titration study. 3. Respiratory Finding^ (AM, Severityv& Saturation) 4. Snoring level: 5. ECG: 6. PLMS: 7. Sleep Architect: 8. Medication effects on steCp (if applicable): 9. Other: CLINICAL RECOMMENDATIONS: 1. Treatment options: A) Normal PSG: Fujtt night CPAP titration study: C) Surgery: