JamieNP

Don't get discouraged Karina. We WILL appeal it and get approved!

Did you talk to a human? They should tell you why you were denied. Probably they same reason I was, considering we have about the same stats.

Azair, You need to have a doctor say that the reason they are not putting you on meds right now is because they are expecting you to have the surgery and lose weight. You are diabetic..have you had a sleep study?

I was told by my surgeon's nurse that the Tricare nurse said "I will have to have my medical director look at this" and then 12 hours later it was denied!

If you all haven't heard already, I got denied. They said that I was 6.5 lbs under the required wt. When they read everything else to me, it said that I DID have the comorbidities, it was just that I did not meet the weight requirement, and then listed the requirement for me. So, do I load myself down and put myself at risk for insurance fraud? Do I gain the weight, and put myself at risk for other things? Or do I just skip it and try another doc? Looks like I will be gaining some weight!

Oh, I WILL weigh the required amount...and maybe 3 lbs over for good measure. It just shocked me when the tricare rep read the denial to me over the phone and said what I needed to weigh to get approved.

If it were winter, I would have weighed that amount..but it was 102 degrees outside when I went! I am going next week in my parka, turtleneck, ski hat, mittens (and gloves) longjohns, snow boots, and maybe even the skis too!!

Denied by Tricare! They told me I was 6.5 lbs under the weight requirement!

It is just strange. I guess it depends on who reviews your case. I have heard people being a little under and getting approved. Oh, and according to the "metlife" table (which is what tricare uses), I should be weighed with my shoes on...and my Dr's office has me take mine off (the scale has a print out that they put in my chart). I will definitely go and weigh in again next week. Just pisses me off...

Well, I think I will go back and reweigh next week. I deliberately did not work out for the past 2 months just because I knew I was borderline and that there was a chance that I would have to appeal. I feel my cholesterol shooting up with all of the fried fatty food I have been eating!!

I have heard people having problems with it getting approved because their doc was not a tricare doc. Just call tricare and make sure.

Remember, you surgeon HAS to inform you of the risks of the surgery..One being death. I would say one of the main risks are of a pulmonary embolism, which can kill you. This is when a blood clot from your leg travels to your lungs. So, be sure to get up and move around ASAP after surgery.

You should have no problem with tricare paying for your surgery as long as your surgeon is within network. You are 100 lbs overweight and have a comorbidity, meeting the requirements for tricare. Call your surgeon and make the appointment. Go head and make an appointment for a psy consult (you can self refer for tricare), go to an informational meeting, go to a support group meeting, get your labs together. Good luck!!

Did you have a sleep study? If not, GET ONE! Chances are you have some degree of sleep apnea if you are over weight.

Go for it Karen! What do you have to lose? (well, they could send you in for another Psy exam, :tongue_smilie: I am still "Pending" on the Tricare site. So I called Tricare to see what was going on. Apparently they have sent it to the post hospital (which I have never had anything to do with, and my surgeon is not there) and they have to refuse it first and then it is sent out to a local surgeon. She said that usually that means I am approved. I should find out something officially tomorrow. So, I am thinking..does that mean I am approved?!?!?! The soonest that my surgeon can get me in is Sept 23. I guess I am a control freak...the waiting is KILLING me!!

I work in the CCU...heck I was thinking about going back to work in 3 days..maybe I will rethink that!

I am still pending. I called Tricare today and they said that it has not been reviewed yet. Argh!! Waiting is the hardest part!!

Tprejean, I also have Humana PPO with an exclusion written in the policy for WLS. They have paid for all of the pre op requirements (the EGD, PSY eval, lab work) but will not pay for surgery. Thank goodness I have a secondary insurance! I am sure I would try to fight it if I had to. I think you have to go through your employer to try to get the exclusion changed, since they are the ones that specifically had it placed there. You could talk to obesity law.

I just finished "One for the Money", our August book. Good book. Sorry it took me so long. I had others that I was reading that I needed to finish ( I usually have 2 or 3 going at the same time). I just bought "Twilight" and "Sunday at Tiffany's".

Lap band IS FDA approved! You may want to enlighten Tricare!

I am so excited! My surgeon's office finally submitted everything, and I am "PENDING" right now...could be any time now before that changes!!

My paperwork has been submitted and now I am PENDING!! Please oh PLEASE get approved!!

I have Tricare North and as of a month ago, they required the overnight stay. Take it if you can get it.

Before I got to the exam room, the nurse asked me to take my shoes and socks off to step on the scales...I think it had a body fat measurement thing on it..

Hi! One of my coworkers sells Shaklee and I am considering their products. They have liquid vitamins (my surgeon will not let us have pills of any kind after surgery) and of course, the cinch stuff. She gave me some samples and I tried the strawberry. I mixed it with water and it was pretty good. Here is the site. Shaklee.com - Official Site - Creating Healthier Lives