hope2bthinr

Just have to rant and rave here for a few...Friday my surgeon's office called Tricare and was told I didn't need pre-auth because I had other primary ins so they are moving ahead as if it's ok :wub: and even set a surgery date (they even got a pre-auth #)... but then the Tricare website today says NOT APPROVED (WTH?? ) so when I called to find out why and what was going on, I was told I did not meet the criteria for the surgery being medically necessary. :smile2: Either the 100lb over ideal weight + 1 comorbidity or >200% of ideal weight ( I met this one at 5'1" 226 and small frame). And of course I find this out right before 4PM so the doctor's office is closed. So I can't have them call today to find out what went wrong. :redface: Anyway, I'm still trying not to get upset, that there must be a mistake somewhere and hopefully it will get straightened out in the morning. :sad: :wink2: :crying: :thumbup: ....I really want to have happy news in the morning!!

Ok, turns out we had to wait a while for a letter of exclusion from my primary insurance before submitting to TriCare. That took till 8/26, then review of my file, then finally it was all faxed 8/28. Great, so I'm thinking...most of these people are getting answers from Tricare within a couple days so I was patient for a few days. Then I made the first phone call. "I don't see anything here" so I asked could they verify they received the fax and they did, then told me it usually takes 1-5 business days to process, so fine. I gave it a few more days and called again. :party: They tell me to call back the next day. That brings us to today... I called this morning,they said well it's here, call back around three. I called back and the person I talked to finally determined that they were holding it for the exclusion letter from my primary ins. And she determined THEY ALREADY HAD IT!!! The entire week went by and they had what they needed all along!!! So I'm SOOOO mad, and I have to wait over the three day weekend AGAIN. At least it shows on Triwest.com as pending medical review. :tt1: I'm so mad at all the delays...uuuuggghhh!!!!! And why did I think that just because I got every single thing they needed for all the doctors quickly that this would be fast and simple??? What makes me madder is my deductible starts over again on October 1st so if I can't get it done before then I get to pay my deductible all over again!!! CRAPPPP!! And my surgeon is a non-network provider so who knows how much is going to come from my pocket. I just want to get done worrying about all of this and get on with losing weight. Fingers crossed till tuesday or weds. :mad:

Thanks you guys. Right now I'm just going to try to remain calm and hope the surgeon can get me scheduled quickly if I get the authorization approved. And yes, I feel like feet were dragging through this whole process (except mine!) since I've been doing all of this process since April sometime. I think if I had gone through a surgical center where they could line up all the tests, nutritional meeting and psych eval in one week instead of 3 months it would have moved a lot faster. But I'm going through a surgeon my primary doctor recommended, who is not a Tricare provider and not up on their requirements, the surgeon isn't a Tricare provider either, so its all gone slower than necessary. Had I known it would be this way I would have gone to one of the weightloss surgical centers that have the routine figured out and are Tricare providers. Tricare is not my primary ins, that's why I waited for an exclusion letter from my primary insurance (which was Aetna, my employer chose to have that exclusion), like I said. Luckily, Aetna paid for some of the testing because the conditions I have warrant them whether I were to get the LapBand procedure done or not. Anyway...on with the waiting game.

Ok, turns out we had to wait a while for a letter of exclusion from my primary insurance before submitting to TriCare. That took till 8/26, then review of my file, then finally it was all faxed 8/28. Great, so I'm thinking...most of these people are getting answers from Tricare within a couple days so I was patient for a few days. Then I made the first phone call. "I don't see anything here" so I asked could they verify they received the fax and they did, then told me it usually takes 1-5 business days to process, so fine. I gave it a few more days and called again. :crying: They tell me to call back the next day. That brings us to today... I called this morning,they said well it's here, call back around three. I called back and the person I talked to finally determined that they were holding it for the exclusion letter from my primary ins. And she determined THEY ALREADY HAD IT!!! The entire week went by and they had what they needed all along!!! So I'm SOOOO mad, and I have to wait over the three day weekend AGAIN. At least it shows on Triwest.com as pending medical review. :cryin: I'm so mad at all the delays...uuuuggghhh!!!!! :smile2: And why did I think that just because I got every single thing they needed for all the doctors quickly that this would be fast and simple??? What makes me madder is my deductible starts over again on October 1st so if I can't get it done before then I get to pay my deductible all over again!!! CRAPPPP!! And my surgeon is a non-network provider so who knows how much is going to come from my pocket. I just want to get done worrying about all of this and get on with losing weight. Fingers crossed till tuesday or weds. :mad:

I was going to say it sounds like they want Stepford Children....but someone read my mind. It sounds like they just don't want to have to deal with controlling the undesirable behaviors that naturally occur and are part of the learning experience, peer pressure results in correcting ones behavior when it deviates too much from the group norm, but there won't be any of that kind of learning in that environment. I wonder if this is some kind of experiment or punishment or if it's like that every day? I don't think I could leave a little bundle of energy in a school run that way. Where do the kids get to blow off steam and develop friendships? This is when they are figuring out who they are and their relationship to the rest of the world. What can they figure out if they're all just staring at each other in silence? Sounds like something you'd see in a creepy movie...

Finally! My paperwork is being submitted to TriCare (my ins) for authorization!!! I don't know what took so long but I'm trying to be patient. First they were waiting for my echocardiogram and EGD results, then I found out only one year of records, not 5 years made it from my primary dr. to the surgeon...now they have everything and will submit! I can't wait! Here I was checking the Tricare site twice a day (like an obsessive) to see if the authorization came through and kept coming up empty. More phone calls, to primary, who says they sent the stuff, then call surgeons office, but in the end, it is all there and complete, reviewed and going to be on its way. Anyway, I've been trying to keep busy at work so I wouldn't become a total pain in the butt. And that worked but now I want an answer!!! Keeping my fingers crossed to get an answer in the next couple days....

Thanks!! So far it's all gone fine, if time consuming. Like anyone who has been overweight for a long time and tried nearly everything to lose the weight, I am so ready to just find out WHEN can I get this DONE so I can get on the road with losing. I'm trying to lose now, but my metabolism is such that if I'm real strict all week and lose three-four pounds, one "normal" meal will bring it all back. So frustrating! But I'm pretty certain I'll get approved. Just wish it was sooner rather than later. Thank you for the good wishes. I hope the best outcome for you as well. I'm Tricare Standard, by the way, so all I need is the authorization and I'm good to go!! :thumbup:

I have to add two cents... psychos like that know the sort of woman to harrass that way, not to say you did anything wrong, but he was betting on the fact you'd be afraid to tell anyone and might be intimidated "for your daughter's sake" to go along with his blackmail. That creep needs some real strategic lesson learning courtesy of every kind of law enforcement and complaint system you can throw at him. It would not be overreacting to do every bit of what is suggested here. I hope you are able to provide all those lessons for him. He isn't the kind to hear what you say that is a "no". He needs it from all directions. Then, sure as anything he'll be telling people what a little c*nt you are for causing all these problems for him. Heck, I'd take my daughter and warn all the other parents about him. When he has no more business, he won't be around very much longer. I know you can't slander him but if there's a way to "help" the other parents see what kind of person is teaching their kids "the self discipline of martial arts" they might think hard about bringing their kids back. You go girl!! I hope it all turns out well for you and your family.

Finally! My paperwork is being submitted to TriCare (my ins) for authorization!!! I don't know what took so long but I'm trying to be patient. First they were waiting for my echocardiogram and EGD results, then I found out only one year of records, not 5 years made it from my primary dr. to the surgeon...now they have everything and will submit! I can't wait! Here I was checking the Tricare site twice a day (like an obsessive) to see if the authorization came through and kept coming up empty. More phone calls, to primary, who says they sent the stuff, then call surgeons office, but in the end, it is all there and complete, reviewed and going to be on its way. Anyway, I've been trying to keep busy at work so I wouldn't become a total pain in the butt. And that worked but now I want an answer!!! Keeping my fingers crossed to get an answer in the next couple days....

chystynaw, so glad you are doing well. Keep up the good work!! Did your dr. clear you already to do that P90X work out program? It looks like it will kick anyone's butt into shape, literally!! LOL! I've thought about ordering that so many times....but I think I've contributed a fortune already to the diet/weightloss industry. The only money I'm gonna part with over this anymore is going to be my gym membership, a trainer maybe a little later, and this surgery. If there was one stock you could buy for the weightloss/diet industry, I would have made enough to retire already!! Because I have tried everything from phenfen to hypnosis and all that's in between. My update--When I thought I was done with all the testing and everything should be moving rapidly forward, it wasn't. My primary was supposed to send 5 years of my records to my surgeon, and it took a while to get ALL of them. Then, I have primary insurance with an exclusion clause but in order to satisfy Tricare, we had to submit and get a decline so that Tricare can decide to authorize and pay for the procedure. SOOO, now that's really ALL done and as soon as the decline is faxed/sent to the surgeon's office, THEN THEY CAN SUBMIT TO TRICARE FOR AUTHORIZATION!!! They already gave the surgeon a verbal and the written form is on it's way. So I'm probably within 3-4 days of finding out if I'm authorized and what my surgery date is!!!!! OMG!! OMG!! I can't believe it!!! I may not make an August date, but probably will in September. Depends on how quick I can get scheduled with the surgeon. OMG!! I'm trying to take off what I can before surgery so I will have that much less to lose. I've lost 7lbs over the last month so I am happy about that. I'm determined to keep at it whether banded or not, restricted or not. I'm gettin' closer to being able to say "I'M BANDED!!!" YEAY!!! Thanks for reading.

I'll try to answer although I'm not banded yet...I've been reading a lot about what kind of diet to follow. Atkins starts out at 20 grams of carbs per day which is pretty hard to do unless you have nothing but high Protein and hardly anything else but green veggies. But I got this link for Lindora.com (clinic in CA) that offers online support and 10 weeks free through the lapband.com site when you sign up to track your online Lapband Journey. So I looked at it and bought the book. They have a little bit different approach, low carb, high protein only for 3 days to start off and then low carb high protein with one veggie or one fruit at each meal, keeping carb grams between 60-100 per day depending on whether you're still able to lose weight. They claim rapid weightloss by this method. So to sum up, if you start out low carb, around 20 per day till you start losing and then increase till you're losing weight at a rapid but healthy pace, that would be what this program is recommending. No definite number, just what works for YOU. I bought the book they use with the program because I was intrigued and plan to do it once I'm banded and use the 10 week period to get a good start. The book is "Lean for Life". It's meant for all kinds of weightloss, whether you've had surgery or not. Found it on the internet through Amazon.com. I would have thought the nutritionist would have talked about this if you had to meet with one. There are also lots of other books regarding low carb diets. My doctor wants me to eat protein first always, then whatever else after I've gotten the protein eaten. But every doctor has their own opinion on the diet they want you to follow. Don't know if this helps, and you'll probably get all kinds of answers on the question with a wide range of recommendations. Good Luck!!!

I'm waiting, trying to be patient, but am not really. I've already been checking the Tricare website....I know, nuts!! But I am so anxious!! I just want to see that authorization and know I can move on with this new beginning.

Well, my last test is done!!! YYEAAAYY!!! Now just waiting on the paperwork to be submitted to insurance for authorization. tick tock! Keep all fingers and toes crossed!! I may be an August bandster!! Woohoo!

I don't have one traumatic thing that happened but rather a few embarrassing ones that got me to make the decision. 1. Coming to the realization that I weigh 100 POUNDS MORE than when I was 30, 2. being so off balance because of the weight I took a really embarrassing fall in front of a whole bunch of people and nearly busted my ankle a few years ago, 3. riding on a plane recently and could just barely get the buckle to reach the receiver but couldn't get it to buckle so I faked it rather than ask for an extender, 4. got up out of a Dr office waiting chair and the chair got stuck on me when I stood (full waiting room of course), 5. and the big one is, I'm at the limit buying larger clothes, I'm not buying ANY MORE LARGER SIZES and I can barely fit in the ones I've got, so that's all there is to it. 6. these are all besides the health problems slowly creeping up on me and not being able to sleep because of feeling like I'm strangling under the weight 7. my back, ankles and hips and knees ache. I was never built to weigh this much. 8. missing horseback riding, skiing, hiking, camping and other activities because it's just too uncomfortable or impossible with the weight being in the way. Bottom line... I just decided I need to be living instead of being a spectator of my life. Too many years have gone by feeling this way. It's time to change!!

Thanks for the encouragement!! At least this is the last test I need, unless something comes up but I'm pretty healthy, so it's unlikely. Turns out I'm scheduled now :tt2: for the EGD procedure on Tuesday so just a few more days!! Then waiting for results from the echo and EGD to get to the surgeons office so they can submit to insurance....so I'm very hopeful I'll be an August bandster. :smile2: OMG!! I can't believe I'm this close....it seemed like forever... I can just imagine what I'm going to be writing when I'm on that darn liquid diet!! LOL! Stay tuned..... I may end up repeating your words!! HA HA HA :wink2: Really, I feel for ya. But it is all going to be worth it, very soon, if we all just hang in there. Right? It is going to feel so good to not carry around these extra pounds.

Ok, I guess mine is going to be strung out a little longer....what I thought was my LAST TEST today, is actually a consult (uuuggghhh!! more money for nothing!! ok excuse me...money for the doctor for a 10 minute visit to tell me he's going to do this or that, then another appointment so another fee can be collected to maximize the wallet weight for the same dr.) and then the test is "scheduled" sometime in the next two weeks. One more delay. My surgeon's paperwork said she wanted the blood tests, Echocardiogram and endoscopic thing within two weeks of the actual surgery but won't file for insurance approval til they are all done. How is that possible if 1. the referrals to these test have to go through my primary to guarantee ins will pay for them just in case, 2. each referral for the test seems to take a week or to to get scheduled, then it's out a week or more 3. and all this is assumng my insurance will move on it fast. I'm sure Tricare will but it has to be filed with my primary insurance first and denied so that Tricare will then give the approval. So that depends on my Primary insurance acting on it quickly too. But again, the surgeon won't submit till all the tests are done...it's like a catch 22!! I'm hanging in there, trying not to get wound up about it but ggeeeezzzzz!! What a royal pain in the butt. Guess that's the price I pay for having extra insurance coverage.... When they told me yesterday that my appointment today was for a consult, not the test, I just want to scream and throw something. I guess because I don't have as much control over just getting the job done quickly and efficiently without big chunks of time going by. BBIIIGGG GGGGRRRROOOOAAANNNNN!!!!! I'm sure six months from now I'll be glad I can say I thought about this 8 months before asking for referral, then waited another 5 months through all the appointments so I had over a year to think about it and definitely didn't rush, BUT THAT'S NOT BY CHOICE!!! LOL

I had my echocardiogram yesterday. THAT was a relief! I had taken Fen-Phen for about 18 months back when that was supposed to be the magic help for weight loss, so I was glad to know my heart is in very good condition, no valve problems, no indicators of disease. Woohoo!! If you knew about all the heart problems that run in my family.... SOOOooo, thursday is my last test required before insurance will give authorization IF they will approve. :thumbup: I willwrite again thursday after the test...

I had my echocardiogram yesterday. THAT was a relief! I had taken Fen-Phen for about 18 months back when that was supposed to be the magic help for weight loss, so I was glad to know my heart is in very good condition, no valve problems, no indicators of disease. Woohoo!! If you knew about all the heart problems that run in my family.... SOOOooo, thursday is my last test required before insurance will give authorization IF they will approve. :thumbup: I willwrite again thursday after the test...

Hey there! Congrats!! I'm hoping for the same outcome with Tricare. My LAST appointment is this thursday and I can't wait!!! All my appointments will be done and most were paid by my primary insurance which won't pay for the surgery (I have Aetna at work and Tricare Standard through my husband). I started out at the end of April and it just seems to take forever to get through this process. But then, I could have pushed harder to get all appts done sooner. I just didn't know how to coordinate all of it to get it done. I've never used Tricare before because I always carried and used my primary insurance. I sure hope they approve me as quickly!!! I don't think they'll have any reason not to :smile2:. Anyway, maybe I'll be joining the August groupies!! Woohoo!! I can sure relate to how excited you must be! I'll probably cry with happiness just to be done with the hoops. Liquid diet? BRING IT ON BABY!!! (please don't remind me that I said this when I'm whining that I'm hungry later...LOL!)

One month has passed since my last post, and I've calmed down and regrouped, I have my last two appointments this week. Once I get those over with my doctor should be able to submit the paperwork. It seems opposite of what is usually done but maybe it's because there are two insurances to go through. one won't pay for the band but will pay for tests and consults. Whatever, I will go with the flow... can't wait for the week to be over!!:confused:

One month has passed since my last post, and I've calmed down and regrouped, I have my last two appointments this week. Once I get those over with my doctor should be able to submit the paperwork. It seems opposite of what is usually done but maybe it's because there are two insurances to go through. one won't pay for the band but will pay for tests and consults. Whatever, I will go with the flow... can't wait for the week to be over!!

Princess, there are a lot of threads talking about different Protein drinks because apparently one kind doesn't work for everyone. Maybe trying samples of different protein drinks would help you find one and a lot of sites offer that, a groups of sample sizes flavors so you can try them out without wasting a lot of $. In my support group there was someone that came and gave us taste tests. She also sells samples at www.greatprotein.com. I liked the chocolate. Didn't like the strawberry, but everyone has different tastebuds. And it's sold by someone that uses her own product. I'm still in the searching stage, pre-op as well. I've tried EAS low carb and they do the big D to me too, at least the chocolate fudge ones do. But taste wise, I love them. Those are in the grocery store and have 17 gr protein each. I've used Isagenix in the past as well, for dieting. It's available on the internet too. Then there are a lot of products at Bariatric Advantage on the internet too. I hope you eventually find one that you like, and I'm sure if you try different ones, with different kinds of Proteins, you'll find one that doesn't give you the trots!! Good luck!!

SuzanneG!! Thanks so much for that info. I want to make sure ahead of time that I can get rid of that adhesive stuff. I have a mental thing about bandaids, tape, and sticky stuff in general, eeuuuww, and was worried about that. (I know, weird thing to be mental about!) I will have to endure it for as long as necessary, but now I will be prepared for when I can get rid of that icky stuff. mbranham, thanks for asking a very important question!

I haven't had the surgery yet but from all of the stuff I've been reading, the FDA (food and Drug Association)approves the use of the gastric band and sets the recommended limits for BMI (in the USA at least) and the band makers themselves have recommendations for use as far as when the risk to a person of staying obese outweighs the risk of surgery. That's probably why you're having trouble finding a clinic or Dr to do it. I hope you are successful, but do weigh those things for yourself. Is it worth the risk? I know when I was back there at that lower weight, I still would have said "yes" knowing my genetics and family history, but that doesn't mean a doctor or clinic (or my insurance) would have agreed. What I would have given not to have gotten this heavy to begin with!! You might try looking for the approval recommendations from whatever agency reviews medical drugs and devices, specifically for gastric bands, in your country. Then see what the exceptions to the rules are. Lot's of research sometimes will help you understand the limits and also how they apply to your case. Good luck!! Sometimes if you just keep hunting for the solution, it will present itself. And I hope this info helps.

HHmm, I'm thinking we did, otherwise we wouldn't have made all the missions afterwards, sent equipment to Mars or have a space station with a dozen+ people up there. Funny thing is though, I guess hollywood had to replace the footage because NASA erased it...so now it's touched up....and that almost sounds like an excuse for not having the original to scrutinize for originality. There are always conspiracy fanatics though that will make something out of nothing. I do have to say though that the equipment they took to the moon looks pretty cheesy when you look at it through our technologically advanced hindsight!