BMI of 34.1, TRICARE STANDARD, MEM MED IN SAV WON'T SEE ME

[faithwade 2]

I've had LOTS of problems with Memorial Health Bariatrics in Savannah. I went to their seminar last Wednesday, and was told by their rep that I'm not big enough to qualify for the surgery. I'm 5'7, and currently weigh 218 pounds. The receptionist who was taking our paperwork told me that the doctor probably won't even call me back, because my BMI is too low. She didn't ask about my co-morbidities or history. She didn't ask me anything. The woman sitting next to her asked me if I was just doing this to get ready for bikini season. Another woman in their group told me she thought I was post lapband, and to go home. I don't need the surgery. I know that I'm not as big as a lot of people, and there are some who may need the surgery more than I do, but I'm still almost 80 pounds overweight, and have 2 comorbidities. Anyway, I called Mem Health a couple of days later, and the same woman from the seminar answered the phone, remembered who I was, and refused to make an appointment for me to see the doctor or let me speak with someone else. She told me that she considers me a self-pay patient, and asked me if I could afford to pay for the surgery our of pocket. If so, then she'd be willing to set up an appointment for me. I told her that I'm a tri-care standard patient, and that my current BMI is 34.1. I also explained that I have stopped taking the prescription phentermine that I'd been on for the past 3 months, and that in 3 weeks I've gained back 8 of the 25 pounds that I lost while on the diet pill. I also told her that my primary care physician faxed a letter to her practice explaining the reasons he feels I need this surgery. She told me that his letter didn't mean anything, and that she doesn't have it anymore (I guess that means she threw it away). She then told me that in her professional opinion, I do not need the surgery. I asked if I could speak to the office manager, and she wouldn't let me. She said that she'd discuss the matter with the appropriate people, including the doctor, and that they would make the decision together as to whether or not they would call me back. I just told her to throw my paperwork away.

Has anyone else dealt with these kinds of problems? I'm just so upset...

[nayttap 4]

The reality is that insurance guidelines are pretty tough.....I'm not saying that you don't have a chance, but it will be a fight. You have many things in your favor with your PCP on your side, the unfortunate comorbidities etc.

Nonetheless, the receptionist should not treat you as she has.........I would call the clinic manager for starters. If this clinic isn't going to work with you, you might need to find another who will.

[millie26 1]

I am in the process of trying to qualify for the LB at Memorial in SAV too. When I went to the seminar last month, they basically told me the same thing. Even though my BMI is 39 she told me that I dont look like I am big enough to get it and that it had to have a BMI of 40+. I am so tired of the back and forth. So they tell me Im obese, but not obese enough? I wouldnt take no for an answer. So, since then, I have seen a sleep doctor and found out that I have sleep apnea. I then called memorial back and explained to them again what my situation is and they finally scheduled me to meet with the surgeon next month. I have already had to jump through a lot of hoops (with memorial and my ins co) and I know there are going to be many more to come, so just hang in there and keep fighting! Good luck!!

[faithwade 2]

The reality is that insurance guidelines are pretty tough.....I'm not saying that you don't have a chance, but it will be a fight. You have many things in your favor with your PCP on your side, the unfortunate comorbidities etc.

Nonetheless, the receptionist should not treat you as she has.........I would call the clinic manager for starters. If this clinic isn't going to work with you, you might need to find another who will.

Thank you for your insight. My PCP and I are prepared to send whatever documentation that's needed. I've been battling obesity all my life, and he's been my doctor for over 12 years, helping me through this process. I have lost large amounts of weight several times through the years, only to gain it back, and more.

The receptionist refuses to allow me to speak to the manager. I asked, and was told no. I realized that I wasn't going to get anywhere with them, and contacted another bariatric surgeon (this one is in Charleston, about 70 miles away) and will be going to his seminar on the 16th.

From what I understand, under Tricare's new standards (as of March of this year), I need a BMI of 35 with 2 co-morbidities. I hate weighing myself because I know I'm probably there now, since I'm off the diet pills.

[ShrinkyDinkyDoo 2]

Hi, Im Tri-Care prime, and live in TX, and I know for us, you have to be 100lbs overweight (BMI doesnt count) with co-morbitidies, or be 200lbs overweight without them. With the place I went, the doctor wouldnt even see you unless you qualified. I rarely saw the actual surgeon. Only once before the surgery, the surgery day itself, and now when I have fills. His staff did everything else. If you dont like them, dont go there, because they are your support group. They are the ones who are supposed to help you through everything, from the first day you walk in the door, to the surgery, to all the post op care for years to come, so please dont go to someone you are not comfortable with.

Its wierd that Tri-Care has different standards for different regions, but you should go to their web page, then type in your zip code, and see what their standards are. The website is www.tricare.mil and it walks you through it. Like I said, I have tricare prime, and I had to be 100lbs overweight according to my height on the Met Life scale, and my surgeon said that Tricare requires them to use the "medium" body frame for everyone. If you google the "met life weight chart" you will find it.

After all that is said and done, find a surgeons office that you like, and go to them with the knowledge that you DO qualify. Tricare requires a visit with a psychologist, and most surgeons offices require a visit with a nutritionist and once all that is done, it takes about 4 days to get an approval from tricare. They are the fastest insurance.

If you have any other questions, please feel free to ask. This process is so much easier when you know someone who has had to deal with the crap first, and can guide you through it!! Good luck

[katwomantexas 2]

I've had LOTS of problems with Memorial Health Bariatrics in Savannah. I went to their seminar last Wednesday, and was told by their rep that I'm not big enough to qualify for the surgery. I'm 5'7, and currently weigh 218 pounds. The receptionist who was taking our paperwork told me that the doctor probably won't even call me back, because my BMI is too low. She didn't ask about my co-morbidities or history. She didn't ask me anything. The woman sitting next to her asked me if I was just doing this to get ready for bikini season. Another woman in their group told me she thought I was post lapband, and to go home. I don't need the surgery. I know that I'm not as big as a lot of people, and there are some who may need the surgery more than I do, but I'm still almost 80 pounds overweight, and have 2 comorbidities. Anyway, I called Mem Health a couple of days later, and the same woman from the seminar answered the phone, remembered who I was, and refused to make an appointment for me to see the doctor or let me speak with someone else. She told me that she considers me a self-pay patient, and asked me if I could afford to pay for the surgery our of pocket. If so, then she'd be willing to set up an appointment for me. I told her that I'm a tri-care standard patient, and that my current BMI is 34.1. I also explained that I have stopped taking the prescription phentermine that I'd been on for the past 3 months, and that in 3 weeks I've gained back 8 of the 25 pounds that I lost while on the diet pill. I also told her that my primary care physician faxed a letter to her practice explaining the reasons he feels I need this surgery. She told me that his letter didn't mean anything, and that she doesn't have it anymore (I guess that means she threw it away). She then told me that in her professional opinion, I do not need the surgery. I asked if I could speak to the office manager, and she wouldn't let me. She said that she'd discuss the matter with the appropriate people, including the doctor, and that they would make the decision together as to whether or not they would call me back. I just told her to throw my paperwork away.

Has anyone else dealt with these kinds of problems? I'm just so upset...

I am like you. My BMI was 34.6. I had to gain 2 pounds to be able to start the process of the 6 month diet required by my insurance. I am also only 80 pound over weight with massive comorbidities. I needed help now. I didnt want to have to wait until I had 200 pounds to lose. It seems to me you should look for another doctor. They should have never told you are not big enough. Good luck on your journey.

katwomantx

[nayttap 4]

Is this place a "Center of Excellence"?

In any case, I would think that a personal letter outlining your situation, marked "personal & confidential" sent to the lead surgeon or clinic manager might be in order as you move on to a facility you can work with and trust.

[lizzy2150 3]

Wow. That's horrible. I would send a letter marked "confidential" directly to the surgeon. Doctors rely upon their staff to be the front line "face" of the practice, and are often unaware when they have snarky office help (since the type of people who like to play power games of those sorts are generally incredibly nice to the doctors). If nothing else, the doctor needs to know that his staff is refusing to allow you to speak to the office manager.

And I agree with nayttap--send the letter, but move on to another surgeon (and be clear in the letter that you are doing so because his office "help" was singularly unhelpful).

That's what I would do, anyway.

[faithwade 2]

I am like you. My BMI was 34.6. I had to gain 2 pounds to be able to start the process of the 6 month diet required by my insurance. I am also only 80 pound over weight with massive comorbidities. I needed help now. I didnt want to have to wait until I had 200 pounds to lose. It seems to me you should look for another doctor. They should have never told you are not big enough. Good luck on your journey.

katwomantx

thank you, Kat. I have TriCare. Do you have any experience with them?

[katwomantexas 2]

thank you, Kat. I have TriCare. Do you have any experience with them?

I do not have Tri Care. I had Cigna. I did my 6 months of visits then the doctor sent in all my paperwork and I was approved in 2 days.

Hope you get your approval.

katwoman

[54Shirley 105]

I would do what some of the people on this site have done.

I would put on ankle weights. have ankle weight above the pair your wearing, so it's on the calf, have a couple of them taped around your back also.

NOW ! Mind you, I am not kidding... If you want this bad enough, then you are going to have to do whatever it takes to raise your BMI, or,,,

this is not going to happen for you.

I don't care where you put the weights, just so its not noticeable, also drink as much Water as you can.

Hook up with a different Dr. if you can.

Your not the first to do this ! There have been plenty of women on this site that have done this.

Is it cheating Yes! Do you want it bad enough? Have you paid into your ins. for a while Yes !

It all balances out in the end, and you get what you want, and need.

[roziecakes 20]

I am sorry that they have treated you this way. I think that 80 pounds is no small potatoes to lose. I would say try to get a different doctor; someone who will actually look at your individual case rather than just assuming that you don't need the surgery because "only" have 80 pounds to lose. We're all different, my goodness. I wish you were out here on the West Coast, I would refer you to my doctor. Best of luck!

[faithwade 2]

Naytap, thank you for your response. Yes, this is a Center of Excellence. One of the reasons I chose them. They are a very highly regarded facility in our area. It seems that I'm just not 'fat enough' for them (or their office staff).

I went to a different surgeon's seminar last Thursday, and they were great. It was such a positive experience, and I feel so much better. I met some of his office staff, and he was there to conduct the seminar, and then they all stayed late to answer questions for all of us. I see his nutritionist and exercise physiologist this Thursday, and will have my first appt with the doctor that afternoon. (I'm fitting all I can in one day because this doctor is about a 2 1/2 hour drive one way).

[faithwade 2]

I am sorry that they have treated you this way. I think that 80 pounds is no small potatoes to lose. I would say try to get a different doctor; someone who will actually look at your individual case rather than just assuming that you don't need the surgery because "only" have 80 pounds to lose. We're all different, my goodness. I wish you were out here on the West Coast, I would refer you to my doctor. Best of luck!

Rozie, thank you so much for your kind words. I wasn't sure if I should keep trying, but I went to a different doctor, and am VERY happy with him and his office. This is a much better fit for me; they are positive, supportive, and are working with me. I DO qualitfy for lapband through Tricare, and will be seeing the nutritionist/exercise physiologist this week, along with my first appt with the doctor. I'm so ready...

[faithwade 2]

I would do what some of the people on this site have done.

I would put on ankle weights. have ankle weight above the pair your wearing, so it's on the calf, have a couple of them taped around your back also.

NOW ! Mind you, I am not kidding... If you want this bad enough, then you are going to have to do whatever it takes to raise your BMI, or,,,

this is not going to happen for you.

I don't care where you put the weights, just so its not noticeable, also drink as much Water as you can.

Hook up with a different Dr. if you can.

Your not the first to do this ! There have been plenty of women on this site that have done this.

Is it cheating Yes! Do you want it bad enough? Have you paid into your ins. for a while Yes !

It all balances out in the end, and you get what you want, and need.

The thing is Shirley, that I don't need to gain anymore weight to qualify for the surgery. I already qualify....and they had a copy of my PCP's letter, stating my 2 comorbidities.