So, I have been lurking the boards reading as much info as I can and reading up on Tricare policies prior to approaching my PCM. One thing I keep seeing is talk about co-morbidities and I was wondering if this is the same as the 3 additional requirements for Tricare approval if you are only 100 pounds over weight?
I need this surgery but I am not sure where to begin and scared of denial. I cannot even get Tricare approval my thyroid medication anymore! (brand name vs generic).
I am 29 years old. I see a neurologist, an endocrinologist, a gastroenterologist, and I am on a wait list for the rheumatologist I want to see. I am also under the care of my OBGYN because I am scheduled for a hysterectomy next week.
I have uterine fibroids, and endometrioisis which has blocked one of my ovaries from producing some of the hormones I need, but they cannot give me estrogen because it would only make the condition worse. Given this I am having the surgery to save my "good" ovary.
At 21 I was diagnosed with facet joint disorder in my back, at 19 I developed hypothyroidism with a TSH level of 98 I take 3.75 mcg of what used to be Synthroid but now take the generic (another story) and my levels are no longer stable. I had my gallbladder removed at 18 due to severe gallstones and bile leakage. I had my first surgery to remove ovarian cysts at 22. Almost four years ago I developed neurological symptoms that they have not given a name to yet (they keep changing their minds) but the result was muscle failure, atrophy, and loss of some of motor function in both my feet and ankles with left sided arm weakness. This year I had my first colonoscopy because I developed ischemic colitis and have my repeat colonoscopy next month because the GI doc thinks I may have ulcerative colitis but was unable to get a clear view due to all the inflammation in my colon at the time. I am on approximately 13 different drugs at this point in time. The endocrine doc is the one pushing for me to see the rheumatoid doc because he thinks all my problems are the result of an autoimmune disorder that just hasn't presented itself at the right time while the docs use me as a lab rat.
Anyhow, I see a doc off base (I am prime though) who was my doc as a teen into adulthood until we transferred and then came back to the area. He has watched me struggle for years and he said for most people that it is a matter of calories in calories out but that a small percentage of people such as myself just cannot lose the weight. I am 120 pounds overweight with a BMI of 36 and the only time I was able to lose any weight was when I paid for a medically supervised liquid plan. However, one can only go so long on 600-800 calories a day before you plan just get hungry and break down. If I had the support of lap-band I could do that and not crack because my belly would be full on a VLC diet.
My mother is pre-diabetic, has lupus, and has been overweight all her life. My grandmother has been the same way suffering heart attacks and other major illnesses. I do not want to be like them. I desperately want to lose weight so that maybe perhaps some of the issues described above might improve or go away entirely. I want to be able to play with my kids, and my grandchildren one day.
I am just not sure if all or any of my health issues will make a difference or not to Tricare when it comes to approval. Thinking fiscally if I was able to get off one particular medication it would save Tricare $800 a month. Right now it looks like I only match one of the three requirements and that is my thyroid. Does anyone have experience or knowledge of them approving Lap-band surgery for conditions not in the three requirements? I do not even know if I have high bp because I take a beta-blocker for anxiety because I have mitrovalve prolapse. Just not sure if this is something I should proceed with or not given I do not meet all three requirements and would appreciate any and all feedback or experiences you have had good or bad.
Thanks so much for reading this very long post!
