Can someone explain this to me????

[soooconfused 0]

Went for a physical on the 6th. Just a routine physical. Doc "mentions" lapband. I have been mulling, and researching, and thinking and meditating like a fool since then. Doc orders cholesterol, diabetes, thyroid, et. tests, and I have had high bloodpressure too so a 5 day blood pressure test.

Ok, so my husband and i come to the conclusion that i would LOVE to get the band. (its not like i haven't thought of WLS for the last 5 years) and its like ok what next.

Well I have a "follow up" on Monday to discuss all the results. We plan on telling the doc we want to go foward with Lapband. (were military and our MTF does the procedure)

I am ***** barely***** exactly 100 pounds over my weight according to metlife. Its been the hardest week of my life this last week, to NOT be on a diet!!!!! I am just like a fish out of water!!!!!! I've been on a diet every day of my life for the last 12 years!!!!!! So, Im NOT trying to gain, just not trying to lose................and its so hard im a mess!!!!!

AND GUESS WHAT??????????????? IM DOWN 5 POUNDS!!!!!! wha??????? lol. I want to be so excited but i just don't understand!!!!!!!! Its the 5 pounds that could make me INELIGEBLE for this surgery!!! How does this even happen???????

ARGH im sorry i just needed to vent i guess. Im so confused!!!!!!!

[jensmallwood 0]

It really depends... I think most doctors and insurance companies go by BMI, not strictly "100 pounds." Find an online BMI calculator and see what yours is.

Uh, the "good news" is that the high blood pressure counts as a "co-morbidity." Generally with one or two co-morbidities, your BMI only has to be 35 to qualify for the surgery (which is less than 100 pounds overweight).

Try not to stress! Good luck! I guess you could drink a lot of Water before your next visit- and wear heavy shoes! :thumbup:

[soooconfused 0]

thanks for the reply. As far as I have been able to find, tricare requires 100 pounds over weight, not BMI.............but someone on here somewhere did say tricare now uses BMI, so im not sure.

[Kalipso2 25]

i was self-pay but when i went to see my doc for a fill this past weekend, there was a new patient and she got on the scale and got back off. she put her coat and shoes on and got back on the scale and got back off. she then picked up her purse and got back on the scale.

there are ways for you to "gain" 5 pounds for insurance reasons and your doc should be aware of that. if all else fails.. a couple of ankle weights should do the trick!!

[MrsCabes 2]

Typically, it is a certain BMI AND a co-morbidity.

However - good luck to you!!! Lapband was one of the best choices in my life!

[angermom 0]

They go by the date/weight that you had your first appointment with the doc.

I said the same thing to the nurse. I told her the insurance company would pull something in order not to pay.

She assured me they use that first weight.

:cool:

Edited April 14, 2010 by angermom

[JMV18 0]

This is directly from the Tricare manual:

• Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints
  
• Is 200 percent or more over ideal weight for height and bone structure
  

I've heard that they stick to this to the T, but I'm not sure. I just had surgery last week and through the whole process had absolutely no problems with approvals through Tricare (from start to finish). All the approvals were also done very quickly. They should use that initial weight and since you have hypertension you should qualify. I was well over the 100lbs but I also have High BP too.

[MLBL 2]

I am just starting my journey with this. We are military too. The Bariatric clinic at Naval Medical Center Portsmouth told me BMI 35 with co morbidity or 40 without. HTH

[soooconfused 0]

thank you kind people! Does anyone know what criteria they use to determine if you are "100 lbs" overweight? I have seen that "metlife" chart, but there is a small frame, medium frame, and large frame. Then with in EACH frame, there is a low and high......................

[angermom 0]

According to my surgical binder, they use the Modified Metropolitan Life Insurance Company Height Weight Table 1983.

Met life ideal height weight tables references

Click above!

:cool:

[LinetteH 0]

The rules for on base surgeries are different than off base. I had to do the psych eval, and had a long history of weight issues in my medical charts already but other than that I was just 100 pounds overweight with no co-morbidities. The huge bonus is Tricare had ZERO to do with my surgery since it was done on base by a military doctor. I kept worrying about Tricare until it hit me one day that I would not ahve to worry about them at all!

[HAL380 0]

Kalipso said "there are ways for you to "gain" 5 pounds for insurance reasons and your doc should be aware of that. if all else fails.. a couple of ankle weights should do the trick!! "

Yeah what's worng with alittle fraud.:cool:

Regards

Hal

[soooconfused 0]

Thanks for the replies everyone! Linette that is great to hear too :-) Im still down the 5 pounds. Its pretty much in Gods hands at this point hhehehe but it sure is maddening at times!!!

[adagray 1]

I would pig out on some carbs and salty stuff. This will help you retain Water before your weigh in. Then, just cut the carbs and salt again after and drink a lot of water to flush it through. Best of luck to you!

[teachkdz0507 7]

Sooooo confused,

Don't fret yet. I was in the same spot as you. I had never been considered small in my life and then all of the sudden I was teeter-tottering on a refusal. Co-morbidities might be your answer. High blood pressure, high cholesterol, thyroid disorder, any kind of muscle or joint disorder are all considered co-morbidities and they allow you to have the surgery with a lower BMI. Ask about that at your visit. Good luck!