tkee99516

That's why they advise you to go to your MD because a "A physician would use a caliper" per the directions.....

Congrats! I'm glad your appeal was sucessful... Best of Luck to you & keep us informed of your weight loss journey!

Way to go! 28 lbs is great! I thought about going to Mexico if I couldn't get Triwest to pay for my Lap Band. They first rejected my authorization, but I did an appeal & it is now approved. I'm having Dr. Searles do the band on 8-25-09 (after dipnetting for the Kenai fish in July, of course!). Let us know how you are doing in your weight loss journey! Tammy

Cool - 2nd post ever! I also am seeing Dr. Searles & have scheduled my surgery for 8-25-09.... Keep in touch & would love to hear how you do.... Tammy

I also was originially denied by Triwest Prime due to the fact they stated I didn't meet the critieria of 100 lbs + 2 co-mobidities or over 200% my idea body weight using the Met Life Table. My stats: Height: 5'3" and 227 lbs with no co-mob other than high cholesterol (doesn't count with Triwest). The denial from Tricare was based on the fact the surgeon's office stated in their request for authorization letter that I was a MEDIUM BUILD (they did not measure my elbow). The Met Life Tables states for my height & Med Build to be in the range 121-135. So using the 200% method (the only one I could qualify for) I would have to weigh in at 242 plus. So what I did was go back to my off base MD, had him measure my elbow, and found out I was a SMALL BUILD (at 2 1/8 inch). Having a small build, a woman, height of 5' 3", and weighing 226 PUT ME IN THE 111 - 124 LBS ideal weight bracket. Then I had this same MD write an appeal letter for me telling Triwest they had misinformation from the surgeons office regarding my frame (again, surgeon's office never did take a measurement & assumed I was a Medium frame). In the appeal letter we used the 200% (111 x 200 = 222 lbs) as my being overweight & requiring the surgery. So Triwest took ALL 60 days (yes, they are little buggers, arent' they?!) and authorized approve for my lap band which will be scheduled for 8-25-09. So folks - MEASURE your elbow. You just never know....:confused::blushing: P.S. Here's a website for the elbow measurements (scroll all the way down) using the Met Life Table that Triwest uses: MetLife Height-Weight Tables

Greetings! Long time lurker, first time poster... I currently reside in beautiful Anchorage, Alaska & have scheduled my Lap Band Surgery for 8-25-09. Was initially denied from TriWest and had to go through their LONG appeal process. Amazing how they take ALL 60 days of the appeal process to finally come through with their decision to reverse the denial (but I won't complain! It worked!).... Hope to glean a lot of information from this site as I am just about to begin my weight loss journey.... Tammy

Thank you! Noticed your from KY - Majority of my relatives including my mom & dad are located around Corbin/Somerset/Lexington area. Beautiful state!