DaniKLargo

Thanks Aprilcat. That's good to hear.

If anyone has a story like this (Catch-22), I'd love to hear it. So I was referred for a sleep study by my PCP a month ago. I never received the referral, so I called, and they said I didn't need a referral for a sleep study. So I said OK, where do I go, what do I do to schedule this thing? And she said "It will be on your referral paperwork." So I said, "oh, I'm getting referral paperwork?" And she said, "No - I just told you you don't need a referral." OK - after going around like this for a while, she finally says, "You don't need a referral for the study, but you need a referral for a doctor to read the study." So I said, "OK - so how do I get that?" She said to ask my ENT doctor. So I said, "I don't have an ENT doctor - how do I do this?" And she said - yes you guessed it ..."you need a referral to see an ENT dr." Although this is Tricare, I'm sure there are some other doozies out there. I'd love to hear some stories so I know I'm not alone in some crazy alternate universe.

It's finally resolved, but I had to have the PCP talk to the Tricare office to get it all right. There's onlty one doctor in the area who does the sleep study, so from the time I first requested it, through all this mess, to my appt it will be over 2 months. AAaaarrgghhh!!! Thanks for your help Randi. :confused:

Don't forget the travel is deductible also, and for the person going with you. Lodging is limited to a deduction of I think $50/night, meals not deductible, but mileage is. Keep very good records - also be able to show it was mediclly necessary. Check out irs.gov for more info.

Macy Woman is my favorite - the smaller Macy's don't have such a great selection, but the one in NYC has a whole floor to plus-size. And if you shop the sales it's cheaper than Lane Bryant and better quality. I also like JustMySize.com - especially for bras, and Land's End for work clothes - sweater sets, etc. I agree Lane Bryant is kind of flashy for me, and LB and Avenue pants are always too long (I'm 5'4") Right now I'm trying not to buy any new clothes - I hope to have my surgery by the end of the year and go crazy shopping for smaller sizes!!!

Mary I have my own special relationship with the BK drive-thru guy :-) He knows when I'm late for work or been on vacation - some weeks I see more of him than my husband. I think this would qualify as an unhealthy relationship all around, but I just keep going back :-)

Thanks Becky - how did you like Dr. Bass? Any propblems? Dani

Thanks for the link Randi - I'll definitely consider that, since it's looking like self-pay for me. I researched Aetna, and it's not looking good. Due to my yo-yo dieting, I don't have a documented BMI high enough consistently over the past 5 years. Oh well. On the other hand, I'm feeling very good right now. I wrote a letter of complaint about the LCDR at the base clinic that was so rude to me about my weight. I've never written a letter like this before, but wow it feels good. Now I just have to get up the nerve to mail it. Then I'll derfinitely be switching to Tricare Standard - no way do want to see her for my pap smear after she finds out about the letter

If you do the 6 or 12 month diet, make sure you have the medical proof. The dr. I did mine with is no longer in practice - can't track her down, and my weight-watchers logs didn't cut it. Stupid me I didn't have my records forwarded when I moved, so I'm SOL on that front. Plus if it was more than 2 years ago, I was told it doesn't count. If you ask me, that requirement is BS anyway. The band is a tool to help people follow a weight-loss program right? personally if I were able to follow a program successfully without help, I wouldn't be asking for the band. Good luck.

I agree with Randi on the fills - get the codes and call Tricare. As far as complications, when I met with my Tricare reps, they gave me a copy of Tricare Policy Manual 6010.54-M, August 1, 2002, Chapter 4, Section 1.1 which states basically that complications from noncovered surgery or treatment are not covered unless the complication is "an unexpected complication which is untoward based on prior clinical experience with the procedure." I took this to mean that slippage, blockage, erosion, and infection are not covered, but if say, your big toe falls off, they'll help you. Welcome to the "dependents" club. (I hate that word!!!)

Randi - Thanks for your info. I think you're right, and it's hopeless. I'm not sure I'm going to wait until next year to see if it's covered in 2007, and I'm heartsick at the thought of subjecting myself to any more military health-care "professionals" who tell me that if I really wanted to lose weight I could do it without surgery. Luckily my employer offers Aetna, and I turned it down when I took the job because I thought Tricare would be fine for me. Now I just need to research Aetna policies, or bye-bye 401K. Either way, I'm done dealing with those bozos. Even if they covered it they'd probably farm me out to the lowest bidder and it would be a disaster. (When I had a lump removed from my breast it was by a doctor who specialized in acne treatment. You should see the size of my scar.) Thanks so much for always replying to my posts. It's nice to know there's someone out there going through the same thing, although I wish we had happier experiences to share Dani

I've heard some do the procedure - I'm curious as to people's experiences in case I decide to explore that route. Thanks - Dani

OK get this - I called the 800 number, and I was told that it is covered, and that the provider has to have it precertified - but then it will be turned down because it's not really covered. Huh???? I was also told that some MTFs perform the procedure and don't need authorization. And... the Tricare rules vary per region - I'm in the south, and it's covered but it's not. :couch2: Next step - I'm going through the tricare website and requesting written clarification. Wish me luck.

Randi - Please let me know what Tricare says. Did they give you a reason for turning you down? There's so much mixed information out there, combined with the prejudices of the military doctors in general this is all really frustrating. It seems that nobody really knows the requirements. The paperwork is submitted to "The Nurses" at Tricare. What do they look for? Nobody could tell me. Hmmm - very mysterious and Oz-like. My next meeting is with my PCP on tuesday, so I'll see how it goes from there. Good luck with all this. Dani

I'm on Tricare and one of the requirements is that I had to meet with the wellness coordinator and go on a 6-month diet and weight loss program. Well, I met with LCDR B today and she ran over me like a freight train. First of all she had never heard of the band and kept calling it gastric bypass. She kept going on about the complications and wouldn't listen when I tried to explain how the band is different - no leakage, staples, etc. I told her I'm in a dilemma because Tricare requires a person to be 100 pounds overweight and I'm right there. If I do a 6-month program, of course I'll lose weight, but I'll gain it back. I had printed out my history of weight loss attempts over the past 27 years - she wouldn't even look at it. She said of course I'll fail because I'm not mentally ready to lose weight, if I really wanted to lose it I would, so no surgery will help me, and that if I'll gain it back without the band I'll gain it back with the band. I asked her why she thought I could lose weight and keep it off under her program when I couldn't with any other of the programs I've followed in the past 27 years. She said if I really wanted to lose it I could. I asked her what her long-term success rate was with her program, and she said she didn't know, she doesn't follow up. I asked her if she had ever dealt with anyone who had 100 pounds to lose and she wouldn't answer. She said a friend of hers had gastric bypass and lost the weight and she always tells her it was a waste of time, that she could have done it without the surgery. I sat there in her office and cried like a baby. I'm so disgusted with myself. Then she put in my file that I refuse to cooperate in her required fitness program. So I'm meeting with my PCP Tuesday, and I have a feeling I'm going to have to pay for this out of pocket. I'm so frustrated.

I called Tricare today and gave them the billing code the dr gave me - I think 43770? Anyway they said it IS covered if the conditions are met. That's the kicker - nobody could give me the conditions. There's the rule about being at least 100 pounds overweight, which seems to be carved in stone. My question was - what is my ideal body weight? Well it's according to some life insurance tables, then you have to compute your body type, which apparently depends on the measurement of the bone on your elbow. WTF? Then there's the requirement that you have a 6-month (or 5, depending on who I ask) medically supervised weight loss program prior to approval. If you lose down to say, 99 pounds overweight vs. 100, you no longer qualify. If you don't lose weight, you failed the program and no longer qualify. Either way I'm SOL. The wellness coordinator told me today that my BMI has to have been documented at least at 40 for the past 5 years. Where did that come from? I dunno. She gave me a flyer from the Jacksonville Naval Hospital for gastric bypass and told me the requirements are the same. Then there's the psych eval, nutrition counseling, sleep studies, and various approvals from every specialist I've ever seen. If anyone else has any information that would help with this process, please post it. I'm so frustrated with the arbitrary prereqs and dealing with the military in general.

I called Tricare myself today and gave them the procedure code, and it IS covered - there are just a lot of BS prerequisites. I had to meet with the wellness coordinator on base and she was evil and said anyone who wants to lose weight bad enough can do it without help. She doesn't believe in WLS and put in my file that I refused to participate in her program because I told her if I did her 6-month program I'd eventually gain back any weight I lost. Isn't it fun dealing with military people? Meanwhile, the nutritionist, surgeon and shrink all said I'd be an excellent candidate. And this B%&** can stop the whole process because she's got personal prejudices.

Thanks - I'll check them out.

Randi - Thanks so much for the info. I see a long uphill battle ahead. You don't happen to know where we could find out about the changes coming to Tricare, do you? I really don't want to spin my wheels any more than necessary. I googled it, and all I found were articles dealing with the proposed fee changes - nothing about coverage. Dani

That is so me - drive-thru junkie. I used to eat fast food 3-4 times a day. I still want to but now I'm down to maybe once or twice - it's such a struggle. I've done the therapy thing and OA - no good, so I'm hoping the band will help with those cravings.

Hi everyone - I've been lurking a while, and I've learned so much from this forum! I've been overweight most of my life, and I'm in the process of trying to get Tricare Prime to cover a procedure for me. I just wanted to introduce myself, and thank everyone for sharing their experiences. Dani

I'm in Key West - if anyone else is in this area, I'd love to chat. I don't know anyone around here who has had or is considering the procedure, so if anyone is in Monroe county, please give a holler :-)

Randi - Thanks for the info. I am a veteran and my spouse is active duty. I didn't know I could still go through the VA if I have Tricare - that's what you're doing, isn't it? I've just started the process of getting approved through Tricare Prime, and I wonder if this would be easier if I go through the VA. I read that Tricare requires a person to be 100 pounds overweight and do a 6-month weight loss program before being approved. My BMI is just over 40 w/ comorbidities but if I lose any weight at all on their 6-month program I won't be over the 100-pound mark and I won't qualify for the surgery. The VA doesn't seem to have that 100-pound rule, or did I miss that? I'm also considering Tricare Standard, and as a last resort liquidating my 401K and paying for it myself. I hope you'll keep posting on your progress with this, and I'll call the local VAMC tomorrow and see what they tell me. Good luck! Dani

Tricare used to be called Champus, so I don't know. I'm an active duty "dependent" (hate that word) and my doc used that message to get info for what we need to do for me, so you may want to run it by your PCM.

I'm a CPA - which means I sit at a desk 14 hours a day :-)