IntoLess

There is Scott and White in Temple, call Tricare and see if they will change it to them.....much, much closer. I am seeing Dr Ganta in Austin, and he seems to be a very good doctor, as I have only seen him once. If distance is important, Tricare will change doctors for you.

I go Monday for my consults, then the insurance papers are filed! I have spent the last few weeks trying to prepare myself, but I am confused as to what to prepare myself for, let down because of insurance denial, or the joy of being accepted. My insurance is Tricare Prime, one of the easiest to be accepted for, but still have my doubts. I spent all day yesterday in my PCM's office getting seen for swelling in my ankles and knees. He is very supportive of me trying to get this surgery and an all around great man, he gave me some pain meds and steriods for the swelling (which I can't take until NEXT Thursday due to allergy testing), BUT anyway, back to my doctor, he said he had no doubt that my insurance would approve it, and my problems will no longer exist when I lose the weight. I am so excited at the thought of having this great tool to help with my hard work and will definitely be let down if they deny me. Keep me in your thoughts and prayers this weekend, and maybe as a group we can get me approved!

My PCM told me when they send it in for the consult, they have to put your weight, height, and BMI. BUT when it comes to actually having the surgery approved, Tricare looks at how much you weigh and any comorbids (problems due to weight) that you have. They say on their website you need to be at least 100 lbs overweight and have at least one comorbid (diabetes, high blood pressure, osteoarthritis of the weight bearing joints, etc) OR be 200% over your recommended weight. Tricare uses the MetLife scale to determine this Met life ideal height weight tables references Unless otherwise stated by your physician, everyone is considered to be medium build, so take that into consideration when looking at the chart. That being said, I know a few that haven't been 100 lbs over who were approved, but a few that weren't 100 lbs over and denied. Also a few that met the criteria and needed to resubmit paperwork (maybe something was left out the first time????) to get approved. I am hearing that they are approving left and right here lately, so we shall see.

Congratulations, Gina! I am so happy for you! If you need anything PM me, maybe we can swap numbers and do this together! (If I ever get approved!!!!!) If I don't get approved, I will still support you, let me know if you need anything! Kitty

We are at Hood too. I am going to Dr Ganta down in Austin. I started to go Temple, but I am so tired of driving there, my PCM is in Temple, and Austin has so much to offer as far as entertainment, so I am not going down for "just" an appointment. Plus, GolfSmith is down there, and my husband always needs an excuse to go to GolfSmith. My surgeon still hasn't put in my paperwork, so HOPEFULLY it will get done today----they said they would do it yesterday afternoon, but they ALSO said they would do it first thing Tuesday morning when I was there Monday......We shall see.

Met life ideal height weight tables references Unless otherwise specified by your doctor, everyone falls in the medium category. I couldn't get a straight answer from anyone at tricare as to whether they go by the high end of the scale or somewhere in the middle.

It used to be two, this is from tricare's website tonight: Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints

Tricare doesn't require the 6 month diet. They should cover psych eval, if you go through your PCM. My surgeon has psych, nutrition, and exercise consultants in his office, and makes everything so much easier. Maybe your surgeon is requiring the six month diet to see how you follow instructions, you may want to clarify with him and Tricare.

Tricare Prime is the same no matter where you are....Here is your problem, Tricare requires you be 100 lbs over weight (which you are) AND have two comorbids. OR be 200 lbs overweight and NO comorbids. I have spoke with people who have no comorbids and be 100 lbs over and get approved, BUT it is very rare. My problem is I currently have one comorbid, but that depends on my blood work because I think I am diabetic (swelling, tingling in hands, always thirsty, etc). If they take my HBP diagnosis from a couple of years ago I am good to go. We shall see. I wish you luck. Don't hesitate to call Tricare, they have been fairly good to me when I call. Ask them what you have to do to qualify for the surgery. Then ask if there are exceptions to the comorbid rule. I honestly think it depends on the person reviewing your case, I hope you get one in a great mood!

Check on your referral Monday morning, referrals usually only take a day or two to get approved. The lady who does our referrals put mine in on Thursday and I got a call from the surgeon's office on Friday to set up my initial appointment. The long part, at least for me, was between my initial appointment and the one on Monday for a re-weigh (I was 8 pounds under 100 over weight), a nut consult, psych eval, and exercise consult. I will find out Monday exactly how long it will take Joy to put in my surgical approval.

This is great news! I am happy you got approved, I only hope mine goes as well!

Talk to your insurance company and find out what their requirements are for approval. Every insurance company is different, then different policies within the company vary as well. Find out exactly what it will take to get approved, be direct, be persistent, and be nice.

Where are you stationed? I am hoping for the best for you! My PCM said yesterday that Tricare was approving them left and right, so hopefully we have a shot!

All of their approvals come fairly quick. The longest part for me is waiting for the girl in my doctor's office to put the referral in. It takes her almost a week to put in the referral, then within 48 hours I have my answer. I have my appointment Monday afternoon, hopefully the insurance girl at the surgeon's office is quite a bit faster at putting in requests than the one at my PCM's office.

If you are tricare prime, it will be covered 100%, tricare standard requires the deductible be met.