SCARED TRICARE standard WILL SAY NO

[purplewawa 0]

I have tricare standard so i havent talked to my PCM about the surgery, i dont think she would be very supportive. I am 5/6 or 7 and I am 225, with a BMI of 36. I have high blood pressure, depression, and knee pain. I want the surgery so bad and I am scared they will say no. Has anyone else that is not over 100 lbs got approved? I went to the seminar today and should be getting a call from the surgeons office next week.

[riverat 1]

2 years ago I was in a similar situation. I had Tricare Prime and was just under the 100 lb/BMI 40 line. I had high cholesterol and various other issues- back pain, GERD, etc. I was told over and over by my doctor's office not to worry- that Tricare was the easiest to work with and they rarely saw denials from them. Well, you guessed it: I was denied. Not enough comorbid conditions. I appealed, but it didn't work.

A couple of weeks ago I was diagnosed with mild hypertension. I literally walked out of my PCP's office and called the surgeon's office from the parking lot to make an appt to try again. Tricare approved it without a hitch- I only had to wait a couple days for the approval. I'm scheduled for surgery on Dec. 27.

It's hard for someone else to guess what will happen, but here's my take: I really got the impression my case was uncommon. Everyone in the office was shocked I was denied, since they deal with Tricare all the time and said even people with lower BMIs get approved easily. The second issue is that you've already been diagnosed with HTN. I expect you'll be fine

Let us know the verdict. I'm curious. Good luck!

[LaborLovinRN 0]

My BMI is 36, I am about 50-60 lbs overweight, less than 3 months ago I was diagnosed as diabetic. That was my golden ticket to approval. As soon as the doctor gave me my test results, which I already knew as I had been tracking my own blood sugar at work, I called the bariatric surgeon at my hospital and said let's get this going. I had my band placed last Friday, December 3rd. I refuse to be diabetic and I knew this procedure would be of great value to my health, but no the real work begins! Good luck to you, I hope you are able to get the insurance to approve the procedure - and quickly!

[L12 13]

If you have Tricare Standard, you don't have a PCM. You might have what you consider to be your primary doctor, but Standard does not recognize a Primary Care Manager for you, as it does not require you to get a referral to see a specialist. Wait and see what the surgeon requires, go get it done (who knows, they may find other comorbidities), and then they will submit it all to Tricare to get authorization for surgery.

[Gum Drop 0]

Hi, I am about 85 pounds overweight and also worried that my insurance provider (UnitedHealthcare) won't approve my surgery. I have high cholesterol and high blood pressure. The surgeon's office staff told me to see if I have sleep apnea because if so that would probably clinch the deal. Well, I did and I do. Got a c-pap machine yesterday. Now that I have 3 co-morbidities, the surgeon's office can write up a letter of medical necessity to submit to UnitedHealthcare. We'll see if I get approved. Sure hope so! Good luck getting your approval.

[purplewawa 0]

I heard from the dr office today and I am going in for my psyc eval on the 29th. The lady on the phone said that I am a couple of lbs from being 100 over and I need to be prescribed high blood pressure meds to prove that the weight is causing a problem . I have high blood pressure so I just have to ask my dr to give me a script. I have to pay 150 for the e Val because their psych doesn't work with insurance, but maybe I can send it i'n and get my money back. Only problem is that I have standard and I might end up paying 1000 for the surgery but it's still a great deal. I'll keep u guys posted

[purplewawa 0]

I have my doctor appointment tomorrow! I am getting blood work, ekg, and a chest x ray. I hope I can get it all done tomorrow. After that I have a nutrition consult and a consult with the dr and I should be getting scheduled soon. I'll keep ya updated.

[Andromeda 0]

I finally got my referral in the mail, but when I tried to call them - first I didn't get an answer and then, the number wasn't even to the right office!

In my mind, I'm 120+ overweight, but the only healthy problems I have is allergies, asthma, some chest pains,and back pain. I've been fighting the weight issue for about 5 years now. One Doctor was discussing PCOS with me, but he left and the other doc hasn't bother or doesn't care (as the weight issue is, what I'm told, the reason we can't get pregnant again). I tried to find my area (California) so I could talk to people, but there aren't listings for Lancaster/Palmdale, nor the base. Reading what y'all post makes me nervous because I'm finally getting help, and I don't want to be denied.

Good Luck to everyone!

[sandi55 0]

Hi, I am about 85 pounds overweight and also worried that my insurance provider (UnitedHealthcare) won't approve my surgery. I have high cholesterol and high blood pressure. The surgeon's office staff told me to see if I have sleep apnea because if so that would probably clinch the deal. Well, I did and I do. Got a c-pap machine yesterday. Now that I have 3 co-morbidities, the surgeon's office can write up a letter of medical necessity to submit to UnitedHealthcare. We'll see if I get approved. Sure hope so! Good luck getting your approval.

[Gum Drop 0]

I got my approval! My surgery will be done on March 21, 2011. I'll be going through the Mehta Bariatric Center in NJ and having the surgery done at Somerset Medical Center. Has anybody else used Mehta? He does the surgery with a single incision at the belly button.

Now I am nervous. But I am still going to do it!

They could have done me in January, but we are going on a vacation in February and my hubby insisted that I wait until after we get back in case there are complications.

[purplewawa 0]

So cool, I'm really ex tied for you. I have my consult on Friday and my nutrition appt on Thursday so I'll keep you posted. I really hope go get the surgery asap

[thompsonfalls 1]

So cool, I'm really ex tied for you. I have my consult on Friday and my nutrition appt on Thursday so I'll keep you posted. I really hope go get the surgery asap

I too am on Tricare insurance. I'm just starting this process so I have no idea if they will approve although, I'm at 40 bmi with an artificial hip and knee issues along with high blood pressure and high cholestrol numbers. I am 58 years old and can only hope I will be approved. Next appointment is Thursday the 13 with the wellness clinic. Any help with TRICARE issues will be appreciated!

[thompsonfalls 1]

I have tricare standard so i havent talked to my PCM about the surgery, i dont think she would be very supportive. I am 5/6 or 7 and I am 225, with a BMI of 36. I have high blood pressure, depression, and knee pain. I want the surgery so bad and I am scared they will say no. Has anyone else that is not over 100 lbs got approved? I went to the seminar today and should be getting a call from the surgeons office next week.

I too am on Tricare insurance. I'm just starting this process so I have no idea if they will approve although, I'm at 40 bmi with an artificial hip and knee issues along with high blood pressure and high cholestrol numbers. I am 58 years old and can only hope I will be approved. Next appointment is Thursday the 13 with the wellness clinic. Any help with TRICARE issues will be appreciated!