JamieNP

Cobrien, When you go to your PCM, hand him a list. Include the following: 1.Medications and allergies (if no allergies put "NKDA" 2.Medical history (include anything and everything, esp if it is related to weight) 3.Weight History. I went back to my teens, to now...like every 5-ten years. 4.Every single diet, exercise program, dvd, gym, weight loss program, weight loss medication (Rx and over the counter) that I have tried. Put in there that you lost weight on most, but ended up gaining back more. 5.Family Medical History...everything weight related...cardiac, diabetes, etc etc 6. Cut and paste Tricare's requirements for weight loss surgery. You can get it online from the hand book or find it on one of your threads. 7. Met life's height weight chart. Highlight your ht/wt 8. Figure your BMI 9. List all of the tests/steps you have taken to get this surgery...like the requiremets, ekg, sleep study, labs, psy eval, meetings, etc, etc 10. Just for good measure, you can add some research articles. 11. All of the doctors that you have seen over the past several years...esp if you have seen then for weight related issues. Put their phone numbers on there. I handed this to a PCM that had never seen me before. He was so impressed that he wrote the referral with no questions asked. I told him I was a nurse and I had been researching this, and that I have had patients and coworkers that have had the lap band and GB. Make sure that he orders the following things for you: CBC, BMP, Thyroid tests, EKG, Lipid panel. I wouldn't hurt to get a sleep study if you are borderline. Go ahead and go to any and all meetings you can attend. Good luck!!

My Walmart carries them!

You coumadin use has nothing to do with your weight loss/gain. Don't go off of it unless your doctor says so.

Here are some questions that I asked my surgeon: 1. What are your incidence of band slippage? 2. What are your incidence of port displacement? 3. What are your incidence of MRSA? 4. How often do you fill? and what are the post op visits? 5. If I ever become hospitalized, can I have an NG tube placed? 6. When you do your fills, do you do it under flouroscopy or xray? 7. Who does the fills? 8. What is the most common cause of being unsuccessful in weight loss for your patients (he said "ice cream")

I had 3 brothers...and I always heard.."fatty fatty two-by-four, couldn't fit through the bathroom door", and "Big Bad Bubble Butt Bertha"

We have been at Ft Campbell, since his unit (160th) is there. I missed out on going to Germany (we have been married for 10 yrs and his ex got that trip). Now that my husband has retired, we have decided to stay here (actually Clarksville, TN).

Good luck Cobrien! Maybe we will find out the same time!! My doc is submitting mine sometime this week (as soon as the PSY report gets written up...and I am NOT crazy, by the way!!:cry_smile:).

Welcome! I have learned quite a bit since I joined about 2 1/2 months ago.

I started a new poll for those of us that have Tricare. If you have time fill it out. It is under the insurance threads.

One of my coworkers sells Shakelee and their Strawberry Cinch is pretty good. She gave me some other protein shake samples that I have yet to try.

I am putting together an appeal letter just in case. I have been putting together research articles and all of my medical history. Like I have mentioned many times on here before, my surgeon and his nurse told me that Tricare approves everyone...and they didn't think there would be a problem getting me approved. I just want the waiting over with!!

Doesn't it seem like most of the people that are getting denied end up getting approved? I am getting so nervous..I cant stand it!

I think it is "September Samurai's"

Yeah!!! Hopefully I am next to find out. Everything should be submitted to Tricare this week or next.

My paperwork should all be submitted this week...the waiting is killing me!!

I love POGO...just wish I could hook it up to my treadmill!

This has been a two month journey. The appointments have been made and kept. I had my psy exam and passed with flying colors. My gallbladder has been scanned, and my esophagus has been probed. I have gone to meetings and researched the heck out of this...now is the time to wait....wait...wait. Waiting for everything to be submitted to insurance and for insurance to give the final decision. I am border line of what my insurance requires for Lapband surgery (the 100lbs overweight) only being a few pounds over their low end. I have 2 comorbids (HTN and sleep apnea). I am sooo ready to get this done!

This has been a two month journey. The appointments have been made and kept. I had my psy exam and passed with flying colors. My gallbladder has been scanned, and my esophagus has been probed. I have gone to meetings and researched the heck out of this...now is the time to wait....wait...wait. Waiting for everything to be submitted to insurance and for insurance to give the final decision. I am border line of what my insurance requires for Lapband surgery (the 100lbs overweight) only being a few pounds over their low end. I have 2 comorbids (HTN and sleep apnea). I am sooo ready to get this done!

My doc is in Clarksville at Gateway. You can go to the Tricare site and it will show you when the authorization goes through. https://mim.mytricare.com/Login.auth

Like I said, my surgeon and his office do not think I will be denied. BUT, just in case, I am getting my appeal letter ready!

Lisa,If you have Tricare you have to have your PCM refer you to the surgeon. After your appointment, he will order the necessary tests. Then they will submit it to tricare. Today is my last step (I am getting my EGD today). Once everything is in, my surgeon will submit it to Tricare. He works with Tricare quite a bit, and used to be an Army Surgeon. I live in Clarksville, but I work in Nashville, and I chose Dr. Steely for his reputation and because he knows the ins and outs of Tricare. He didn't seem to think there would be any problem with getting me approved for surgery, and I am on the border line of the requirements. Good luck!

I got a booklet from my surgeon and there are examples of letters in there. I will try to write it out here Dear (insurance Provider contact), I am appealing your decision for denying my medically needed weight-loss surgery. My ht and wt are __ and __ and my BMI is __. As statistics show and as medical doctors, you must be aware that diet and exercise help, but as a long term resolution to permanent wt-loss only 5% of people succeed. I am well aware of the risks with this surgery, but I believe the risks of being morbidly obesity out weigh the risks of surgery. I am _ years old and have been over-wt since I was _ years old. I have been on diets my whole life, having some success, but would always gain the wt back I lost, plus more. I will list the diets I have been on, but never kept any documentation because I could not have known at the time the insurance company would require it. Nor did I know that until this fairly new surgery even became an option for me, I would have to document wt loss before getting the surgery. (list ALL diets, wt- loss products, programs used. If possible, use documentation.) I have many co-morbid diseases, such as ___. (list meds also). You can also list family history related to obesity here.) (discuss everything about how morbid obesity affects your life) Sincerely, (your name)