Tricare advice?

[SpeedyCheeks 0]

Just wanted to see if anyone has found a way around this...I've been referred for a band removal (Big Surprise, NOT!). I was hoping to get referred to the nearest MTF so I could hopefully revise to the VSG because if I have to go civilian I can only get RNY due to the Dr they want to send me to. I will not even consider RNY, severe malabsorption, stricture risks, the five year failure rate, etc. it's just not for me. I was self pay for the lapband 4.5 years ago; circumstances have changed and I can't afford to self pay again. I'm desperate to not regain ALL the weight; my highest was 278 I'm at 233 now but I WAS down to 203. Any thoughts/help will be greatly appreciated.

[Char 7]

I just went round and round with TriCare over this same problem. I finally had to have the band removed because it continued slipping so far that it cut off my food supply. When they went in, they discovered not only had it slipped, but had eroded into my liver! Yikes!!

I finally got my first appointment at Eisenhower Hospital on Ft. Gordon Army base. It took what seemed like 1000 hours on the phone with TriCare, Eisenhower and the base Managed Care office. Here's what I found out about the approval process that should help a lot of you get the care you are seeking.

1.) First and foremost, you will need to locate an MTF with a bariatric program on your own by calling the base hospitals near you and ask to speak directly to the surgery department, ask that person if they have a bariatric weight-loss surgical program, then asking to speak with the head nurse for that specific surgical team. No one will help you find out what facilities perform bariatric surgery. I'm not sure anyone at any MTF (and certainly not anyone at TriCare!) knows who else is out there from the conversations I've had, especially between service branches. BTW, just because you are AF or Navy, you are not restricted to medical service from that specific branch. If you don't have an AF base near you, look for an Army Post, or nearest military establishment.

2.) Once you've located a facility, contact the office that processes I.D. cards and have them register you into the base/post personnel system. You will need to be registered on base so the people who can help you have access to your TriCare/DEERS information. I was able to find someone to help me over the phone once I explained I was a 3.5 to 4 hour drive away from the post. Some bases may require you to come in to the office, so be prepared to make the drive. I had a minor glitch that you may need to know about. There are two segments to the registration database system. There is a main registrar and one that the hospital system works from. When entered into the main system, it is supposed to automatically update your information into the second segment of the base registrar. If you know you've been entered into the main system and the people at the Managed Care office or hospital can't access your DEERS/TriCare info, call the I.D. office back and let them know to manually update your registration information into the other half of their system so the hospital has access to your info.

3.) If you are retired military and are trying to go through TriCare to get your VSG, YOU DO NOT HAVE TO GO THROUGH TRICARE!! (HALLELUIAH!!) You can go directly to the base or post! First, call the base information desk or get on the internet and find the phone number to the base Benefits/Managed Care office. Explain to the advocate at that office what you are trying to do and that you will need a contact name in the Specialty Care/Medical Management department, the office within the Managed Care office that processes requests for specialty services at the base hospital. The office names may slightly vary from service branch to service branch, so don't quit trying if they tell you they don't have that specific office. Just find out the name of the office that has patient advocates who processe medical services through the active duty TriCare system. Remember, these people can't help you unless they can pull your DEERS/TriCare info from the base registration database. This office has access to some of your civilian TriCare info, but not your medical records. Get contact names from the Managed Care advocate and most importantly, the Specialty Care processor. You'll need a name and fax number so your Primary Care Manager and bariatric surgeon can send a referral to the people who can actually help you.

4.) You may need the Specialty Care advocate to ROFR (Right of First Refusal, pronounced "row-fer") you into the base hospital's insurance system. They had to do that for me because I was outside of the 99 mile service limit. Once you're into the base's DEERS/TriCare system, it's time to get your PCM to send in a referal. You will also want your bariatric surgeon's office to fax in the same referal information. Have them put as much information about your condition on the referal (current weight, BMI, previous surgeries and condition of that surgery if revision surgery is needed, name, address, phone, sponsor ID, your social security number, date of birth, etc., anything they feel may be helpful to obtain on-base approval). Also, make sure the fax has contact information to those doctor offices. The Specialty Care manager will probably need to call back and forth between the offices to get all of the information they need to process your VSG request. I gave all my doctors' contact info to the Specialty Care Manager when I spoke to her in case the contact info wasn't on the fax. Having this info on hand will expedite your paperwork.

5.) FYI, your civilian physicians will not be able to enter a request for services into the TriCare online referal system. So if for some reason you do have to go through TriCare for approval to seek treatment on an MTF, the request will have to be done manually. The Managed Care office will tell you if you need to go through the civilian TriCare system first. If you want to try and go through TriCare first, please note there is a 99 mile service limit. I'll explain more about this later. Explain to your PCM's and surgeon's referal specialist that there is no data entry field for what you are asking to have done on the online TriCare system. Tell them they will need to go onto the TriCare website and download the referal request, fill it out and fax it to the Specialty Care advocate and the bariatric nurse you end up speaking with once you find the MTF (Ask the nurse if he or she wants this faxed to her and get a fax # if he or she wants a copy). Should you go through TriCare Prime or be required to go through them first, in that request, your PCM will need to put detailed information as to what surgery you are requesting (the VSG), that you are not eligible to have this procedure done at a military treatment facility and you are seeking approval to go to that facility. Again, make sure you get names, phone numbers and fax numbers once you find these people. The speed at which you can get through the system will depend on you.

6.) Important Note: There is a 99 mile point-of-service limit. If the MTF is farther than 99 miles from your location, TriCare will AUTOMATICALLY decline your request for service. The reason they will give for the denial is "MTF is not accepting patients at this time" which is not the real reason they've denied it." The base will tell you they are accepting patients and TriCare will tell you they aren't. Why? Because your TriCare office's computer system is not set up to handle requests outside of your treatment zone. Their solution is to just tell their patients the MTF is not accepting patients when they should be telling you to go directly to the facility and work through the base Managed Care office. (Insert appropriate obscene or derogatory noun here !!!!) You have the right to obtain treatment through an MTF. Just keep trying and don't accept the word NO!

The TriCare system for retired personnel works from an entirely different pool of government medical funds than the active duty personnel and MTFs work through. The retired TriCare system does not pay for services obtained at an MTF, the funds are paid out of a separate DOD medical funding account. This is why you are able to entirely bypass the TriCare system. The retired TriCare system actually has NOTHING to do with services obtained on base other than a temporary obstruction to getting your VSG. The post Managed Care advocate explained all of this, not TriCare, so don't expect anyone at TriCare to know what is going on or even why their own system is denying you service due to the MTF not accepting patients.

7.) Once the Specialty Care manager has all of your information, he or she sends your information to the hospital for the first step in obtaining the VSG. If you want to stay on top of things, ask him or her to call you when the office visits are approved by the base Managed Care office, or call that person back to check the referal process to see if there's any missing information you can help them obtain. The hospital should contact you get further information and/or set up your first appointment. My first appointment is February 8th! YAY!!!

8.) While you are working on gaining access to an MTF, have your bariatric surgeon print out all of your medical records regarding your surgery and post-op progress. If you've had any complications, make sure the records contain detailed information about what and how it happened. I happen to have an allergy to the most commonly used anethesia. My anethesiologist had to use an older, less synthetic anethesia to knock me out or I'd have woke up puking like Linda Blair in "The Exorcist." I also had post-operative breathing problems and required breathing treatments. It wasn't fun waking up in the middle of the night surrounded by nurses and screaming monitor equipment and looking somewhat like a Smurf. My body also has the uncanny ability to form massive adhesions which will make my surgery long and complicated. The MTF will definitely want to know these things! Ask your doctor if he can obtain any hospital records (anethesia, hospital records regarding anything the nurses had to help you with, problems with pain management, etc.). If he can't (or won't) go to the hospital and get them yourself.

Note: When my first lapband failed, I had to have it replaced 3 months after my first surgery. My doctor told me he'd never seen anyone form adhesions around the band site as heavily and as quickly as I did. He said it took him way longer than expected to remove and replace. When the second band came out, I asked my surgeon to take pictures inside the abdominal cavity so the surgeon at the MTF can get a good look at what to expect once the cutting started. I would recommend asking for photos. Bariatric surgeons tend not to like doing revision surgery on another bariatric surgeon's patients since they are unfamiliar with the patient's history and what may have been done during previous surgeries.

9.) The MTF may or may not ask you to go through all the presurgical appointments with the psychologist and nutritionist. It will likely depend on how far out you are from your previous surgery. When you speak to the head bariatric nurse, ask her about the hospital's pre- and post-surgical procedures and how many appointments to expect. Take all your medical records to this nurse and hand them to her personally. If your psych eval and nutritional counseling are over one year old they're most likely to have you retake the eval and training. Ask about post-op support group requirements, too. I will be required to attend one per month until either 1 year post-op or I meet goal weight (not sure which because I didn't ask...). Since I have to drive so far, I will be allowed to attend a local support group at my previous surgeon's office as long as my current surgeon is willing to provide proof I attended the meetings. If you have nutritional training instructions, paperwork, handouts, etc., it may be helpful in slimming down the number of nutritional counseling appointments. Ask if you can speak with the nutritionist, show her your notebook and see if you can skip some of the nutritional counseling. This will vary from facility to facility. And no...you won't be able to get out of the pre-op endoscopy.

10.) If you currently have a lapband that has slipped, eroded or malfunctioned in some way and require removal surgery, I highly recommend trying to find a surgeon willing to remove the band and do the VSG at the same time. Depending on what they see when they go in, they may or may not be able to do this. If there are too many adhesions, they may need to make you wait until the stomach has time to do a little reformation and stretch out the adhesions at the band site. Because the surgeons consider a slipped or otherwise defective band a hazard to your health, you can probably get onto the surgical schedule faster than someone who's already had to have their band removed.

I know this was a lot to read, but hopefully it will help you and others get their VSGs sooner rather than later with fewer headaches than I've had during my battle with the TriCare system.

[Tiffykins 673]

Absolutely fabulous post, and tons of information. Thank you for sharing.

[MiCollins 0]

Hi Everyone,

I came across this on a google search this morning.

Apparently, the Department of Defense has finally ruled to not disqualify particular types of weight loss surgery, but just requires it to be medically necessary and particularly points to using BMI as a determination (but doesn't specify exactly how)

Here's the link to the Federal Register for TODAY - FEB 14, 2011

Federal Register

http://www.gpo.gov/fdsys/pkg/FR-2011-02-14/pdf/2011-3207.pdf

Looks like it is effective March 2011

I cut and pasted here also in case the link doesn't work.

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DOD–2008–HA–0057]

RIN 0720–AB24

TRICARE Program; Surgery for Morbid

Obesity

AGENCY: Office of the Secretary, DoD.

ACTION: Final rule.

SUMMARY: This final rule adds a

definition of Bariatric Surgery, amends

the definition of Morbid Obesity, and

revises the language relating to the

treatment of morbid obesity to allow

benefit consideration for newer bariatric

surgical procedures that are considered

appropriate medical care. The final rule

removes language that specifically

limits the types of surgical procedures

to treat co-morbid conditions associated

with morbid obesity and retains the

TRICARE Program exclusion of nonsurgical

interventions related to morbid

obesity, obesity and/or weight

reduction. This final rule is necessary to

allow coverage for other surgical

procedures that reduce or resolve comorbid

conditions associated with

morbid obesity and the use of the Body

Mass Index (BMI), which is the more

accurate measure for excess weight to

estimate relative risk of disease. As new

technologies or procedures evolve from

investigational into generally accepted

norms for medical practice, the statutes

and regulations governing the TRICARE

Program allow the Department to offer

beneficiaries these new benefits. These

changes are required in order to allow

the Department to provide these newer

technologies and procedures for the

treatment of morbid obesity as they

evolve.

DATES: Effective Date: This rule is

effective March 16, 2011.

ADDRESSES: TRICARE Management

Activity, Medical Benefits and

Reimbursement Branch, 16401 East

Centretech Parkway, Aurora, CO 80011–

9066.

FOR FURTHER INFORMATION CONTACT: Gail

L. Jones, Medical Benefits and

Reimbursement Branch, TRICARE

Management Activity, telephone (303)

676–3401.

VerDate Mar<15>2010 14:08 Feb 11, 2011 Jkt 223001 PO 00000 Frm 00030 Fmt 4700 Sfmt 4700 E:\FR\FM\14FER1.SGM 14FER1 WReier-Aviles on DSKGBLS3C1PROD with RULES

Federal Register /Vol. 76, No. 30 /Monday, February 14, 2011 /Rules and Regulations 8295

SUPPLEMENTARY INFORMATION:

I. Background

On December 27, 1982, the

Department of Defense (DoD) published

a final rule in the Federal Register (47

FR 57491–57493) that restricted surgical

intervention for morbid obesity to

gastric bypass, gastric stapling, or

gastroplasty method (excluding all other

types) when the primary purpose of

surgery is to treat a severe related

medical illness or medical condition.

The severe medical conditions or illness

associated with morbid obesity included

diabetes mellitus, hypertension,

cholecystitis, narcolepsy, Pickwickian

Syndrome (and other severe respiratory

disease), hypothalamic disorders, and

severe arthritis of the weight-bearing

joints. The DoD also limited program

payments to two categories of patients:

(1) Those who weighed 100 pounds over

their ideal weight with a specific severe

medical condition; and (2) those who

were 200 percent or more over their

ideal weight with no medical

complications required. Program

payment was made available as well in

cases in which a patient, who originally

met the criteria, received an intestinal

bypass, or other surgery for obesity and,

because of complications, required a

second surgery. Payment was allowed

even though the patient’s condition may

not have technically met the definition

of morbid obesity because of the weight

that was already lost following the

initial surgery. All other surgeries

including non-surgical treatment related

to morbid obesity, obesity, and/or

weight reduction were excluded.

The DoD used the definition of

morbid obesity, which was based on the

Metropolitan Life Table and used then

by other major health care plans, as well

as reflected the 1982 general opinion

regarding which cases justify surgical

intervention. The DoD decided, at the

time, that it was necessary to be very

specific in benefit parameters due to

fiscal responsibility and to ensure that

Program beneficiaries were not being

exposed to less than fully developed

medical technology or procedures.

At the time the current regulation was

written in 1982, gastric bypass, gastric

stapling, and gastroplasty methods were

the recognized surgeries for morbid

obesity. However, in recent years, other

bariatric surgical procedures have

evolved and some have a substantial

body of literature to support their safety

and efficacy. Unlike the original rule

that listed the specific surgical

procedures and the clinical conditions

for which coverage may be extended;

this final rule authorizes benefit

consideration for those bariatric surgical

procedures that have moved from the

unproven status to the position of

nationally accepted medical practice, as

determined by the Program standard of

reliable evidence.

Also in 1982 during development of

the current regulation for morbid

obesity, overweight and obesity were

typically measured with height-weight

tables (such as the Metropolitan Life

Table). The 1982 regulation restricted

eligibility for bariatric surgery to

individuals who exceed their ideal

weight for height by 100 pounds with an

associated severe medical condition, or

200 percent or more over their ideal

body weight with no associated medical

condition required.

This final rule changes the Program

definition of morbid obesity to reflect

the current nationally accepted medical

use of the BMI, rather than the typical

assessed height-weight table (i.e., the

Metropolitan Life Table), to determine

an individual’s eligibility for bariatric

surgical treatment. The BMI is the more

accurate measure for excess weight to

estimate relative risk of disease. Since

there now are more than 30 major

diseases associated with obesity, the

final rule requires the Director, TMA, to

issue specific criteria for co-morbid

conditions exacerbated or caused by

(morbid) obesity, as determined by the

Program standard of reliable evidence.

This final rule does not expand the

TRICARE benefit for morbid obesity

surgery. However, it does make the

specific procedures that are covered, as

well as the clinical conditions for which

coverage may be extended, a matter of

policy. In other words, new bariatric

surgery procedures may be added to the

TRICARE benefit structure as such

procedures are proven safe and effective

and are established as nationally

accepted medical practice as

determined by the Program standard of

reliable evidence.

[SpeedyCheeks 0]

Thank you so much for all the info. After A LOT of calling and talking I finally did succeed in getting an on-base referral. My base is only 30 mins away but some of our bariatric surgeons are deployed so they were kickin' us off base. I feel fortunate to have made it this far. However, my surgeon isn't exactly a pro at band to sleeve revisions; he's only done one BUT he is a very sincere, caring, and competent surgeon he's done lots of bypasses. He spent over an hour with me to answer all my questions, he even drew pictures for me to really grasp what he may encounter when he gets in there bc I've had my band for 4.5 years there may be too much damage to do a regular sleeve. Anyway, thanks again it means a lot to have a place to come to that offers so much support.

[Char 7]

Just to clarity something in my earlier post, while you do not have to go through the regular retired Tricare system (that crazy 1-800# and a bunch of cluelessness regarding the VSG), you still have to go through the on-base Tricare office. The Benefits Management office on base is the active duty Tricare office. The funding for the base Tricare for services through an MTF is a different pool of funds than the fund pool which pays out for services obtained through a civilian hospital or physician.

[VSGJean 68]

Char, thanks for all that info. My sister uses Tri-care. I'm hoping she will see how well I do with my VSG, that she will want to do it too. I have to go to Mexico, because my insurance won't cover any WLS.

[Elissa55 8]

I just went round and round with TriCare over this same problem. I finally had to have the band removed because it continued slipping so far that it cut off my food supply. When they went in' date=' they discovered not only had it slipped, but had eroded into my liver! Yikes!!

I finally got my first appointment at Eisenhower Hospital on Ft. Gordon Army base. It took what seemed like 1000 hours on the phone with TriCare, Eisenhower and the base Managed Care office. Here's what I found out about the approval process that should help a lot of you get the care you are seeking.

1.) First and foremost, you will need to locate an MTF with a bariatric program on your own by calling the base hospitals near you and ask to speak directly to the surgery department, ask that person if they have a bariatric weight-loss surgical program, then asking to speak with the head nurse for that specific surgical team. No one will help you find out what facilities perform bariatric surgery. I'm not sure anyone at any MTF (and certainly not anyone at TriCare!) knows who else is out there from the conversations I've had, especially between service branches. BTW, just because you are AF or Navy, you are not restricted to medical service from that specific branch. If you don't have an AF base near you, look for an Army Post, or nearest military establishment.

2.) Once you've located a facility, contact the office that processes I.D. cards and have them register you into the base/post personnel system. You will need to be registered on base so the people who can help you have access to your TriCare/DEERS information. I was able to find someone to help me over the phone once I explained I was a 3.5 to 4 hour drive away from the post. Some bases may require you to come in to the office, so be prepared to make the drive. I had a minor glitch that you may need to know about. There are two segments to the registration database system. There is a main registrar and one that the hospital system works from. When entered into the main system, it is supposed to automatically update your information into the second segment of the base registrar. If you know you've been entered into the main system and the people at the Managed Care office or hospital can't access your DEERS/TriCare info, call the I.D. office back and let them know to manually update your registration information into the other half of their system so the hospital has access to your info.

3.) If you are retired military and are trying to go through TriCare to get your VSG, YOU DO NOT HAVE TO GO THROUGH TRICARE!! (HALLELUIAH!!) You can go directly to the base or post! First, call the base information desk or get on the internet and find the phone number to the base Benefits/Managed Care office. Explain to the advocate at that office what you are trying to do and that you will need a contact name in the Specialty Care/Medical Management department, the office within the Managed Care office that processes requests for specialty services at the base hospital. The office names may slightly vary from service branch to service branch, so don't quit trying if they tell you they don't have that specific office. Just find out the name of the office that has patient advocates who processe medical services through the active duty TriCare system. Remember, these people can't help you unless they can pull your DEERS/TriCare info from the base registration database. This office has access to some of your civilian TriCare info, but not your medical records. Get contact names from the Managed Care advocate and most importantly, the Specialty Care processor. You'll need a name and fax number so your Primary Care Manager and bariatric surgeon can send a referral to the people who can actually help you.

4.) You may need the Specialty Care advocate to ROFR (Right of First Refusal, pronounced "row-fer") you into the base hospital's insurance system. They had to do that for me because I was outside of the 99 mile service limit. Once you're into the base's DEERS/TriCare system, it's time to get your PCM to send in a referal. You will also want your bariatric surgeon's office to fax in the same referal information. Have them put as much information about your condition on the referal (current weight, BMI, previous surgeries and condition of that surgery if revision surgery is needed, name, address, phone, sponsor ID, your social security number, date of birth, etc., anything they feel may be helpful to obtain on-base approval). Also, make sure the fax has contact information to those doctor offices. The Specialty Care manager will probably need to call back and forth between the offices to get all of the information they need to process your VSG request. I gave all my doctors' contact info to the Specialty Care Manager when I spoke to her in case the contact info wasn't on the fax. Having this info on hand will expedite your paperwork.

5.) FYI, your civilian physicians will not be able to enter a request for services into the TriCare online referal system. So if for some reason you do have to go through TriCare for approval to seek treatment on an MTF, the request will have to be done manually. The Managed Care office will tell you if you need to go through the civilian TriCare system first. If you want to try and go through TriCare first, please note there is a 99 mile service limit. I'll explain more about this later. Explain to your PCM's and surgeon's referal specialist that there is no data entry field for what you are asking to have done on the online TriCare system. Tell them they will need to go onto the TriCare website and download the referal request, fill it out and fax it to the Specialty Care advocate and the bariatric nurse you end up speaking with once you find the MTF (Ask the nurse if he or she wants this faxed to her and get a fax # if he or she wants a copy). Should you go through TriCare Prime or be required to go through them first, in that request, your PCM will need to put detailed information as to what surgery you are requesting (the VSG), that you are not eligible to have this procedure done at a military treatment facility and you are seeking approval to go to that facility. Again, make sure you get names, phone numbers and fax numbers once you find these people. The speed at which you can get through the system will depend on you.

6.) Important Note: There is a 99 mile point-of-service limit. If the MTF is farther than 99 miles from your location, TriCare will AUTOMATICALLY decline your request for service. The reason they will give for the denial is "MTF is not accepting patients at this time" which is not the real reason they've denied it." The base will tell you they are accepting patients and TriCare will tell you they aren't. Why? Because your TriCare office's computer system is not set up to handle requests outside of your treatment zone. Their solution is to just tell their patients the MTF is not accepting patients when they should be telling you to go directly to the facility and work through the base Managed Care office. (Insert appropriate obscene or derogatory noun here !!!!) You have the right to obtain treatment through an MTF. Just keep trying and don't accept the word NO!

The TriCare system for retired personnel works from an entirely different pool of government medical funds than the active duty personnel and MTFs work through. The retired TriCare system does not pay for services obtained at an MTF, the funds are paid out of a separate DOD medical funding account. This is why you are able to entirely bypass the TriCare system. The retired TriCare system actually has NOTHING to do with services obtained on base other than a temporary obstruction to getting your VSG. The post Managed Care advocate explained all of this, not TriCare, so don't expect anyone at TriCare to know what is going on or even why their own system is denying you service due to the MTF not accepting patients.

7.) Once the Specialty Care manager has all of your information, he or she sends your information to the hospital for the first step in obtaining the VSG. If you want to stay on top of things, ask him or her to call you when the office visits are approved by the base Managed Care office, or call that person back to check the referal process to see if there's any missing information you can help them obtain. The hospital should contact you get further information and/or set up your first appointment. My first appointment is February 8th! YAY!!!

8.) While you are working on gaining access to an MTF, have your bariatric surgeon print out all of your medical records regarding your surgery and post-op progress. If you've had any complications, make sure the records contain detailed information about what and how it happened. I happen to have an allergy to the most commonly used anethesia. My anethesiologist had to use an older, less synthetic anethesia to knock me out or I'd have woke up puking like Linda Blair in "The Exorcist." I also had post-operative breathing problems and required breathing treatments. It wasn't fun waking up in the middle of the night surrounded by nurses and screaming monitor equipment and looking somewhat like a Smurf. My body also has the uncanny ability to form massive adhesions which will make my surgery long and complicated. The MTF will definitely want to know these things! Ask your doctor if he can obtain any hospital records (anethesia, hospital records regarding anything the nurses had to help you with, problems with pain management, etc.). If he can't (or won't) go to the hospital and get them yourself.

Note: When my first lapband failed, I had to have it replaced 3 months after my first surgery. My doctor told me he'd never seen anyone form adhesions around the band site as heavily and as quickly as I did. He said it took him way longer than expected to remove and replace. When the second band came out, I asked my surgeon to take pictures inside the abdominal cavity so the surgeon at the MTF can get a good look at what to expect once the cutting started. I would recommend asking for photos. Bariatric surgeons tend not to like doing revision surgery on another bariatric surgeon's patients since they are unfamiliar with the patient's history and what may have been done during previous surgeries.

9.) The MTF may or may not ask you to go through all the presurgical appointments with the psychologist and nutritionist. It will likely depend on how far out you are from your previous surgery. When you speak to the head bariatric nurse, ask her about the hospital's pre- and post-surgical procedures and how many appointments to expect. Take all your medical records to this nurse and hand them to her personally. If your psych eval and nutritional counseling are over one year old they're most likely to have you retake the eval and training. Ask about post-op support group requirements, too. I will be required to attend one per month until either 1 year post-op or I meet goal weight (not sure which because I didn't ask...). Since I have to drive so far, I will be allowed to attend a local support group at my previous surgeon's office as long as my current surgeon is willing to provide proof I attended the meetings. If you have nutritional training instructions, paperwork, handouts, etc., it may be helpful in slimming down the number of nutritional counseling appointments. Ask if you can speak with the nutritionist, show her your notebook and see if you can skip some of the nutritional counseling. This will vary from facility to facility. And no...you won't be able to get out of the pre-op endoscopy.

10.) If you currently have a lapband that has slipped, eroded or malfunctioned in some way and require removal surgery, I highly recommend trying to find a surgeon willing to remove the band and do the VSG at the same time. Depending on what they see when they go in, they may or may not be able to do this. If there are too many adhesions, they may need to make you wait until the stomach has time to do a little reformation and stretch out the adhesions at the band site. Because the surgeons consider a slipped or otherwise defective band a hazard to your health, you can probably get onto the surgical schedule faster than someone who's already had to have their band removed.

I know this was a lot to read, but hopefully it will help you and others get their VSGs sooner rather than later with fewer headaches than I've had during my battle with the TriCare system.[/quote']

Hi Char,

I am trying to get a revision surgery at Ft Sam in San Antonio-so far unless the bariatric surgery dept doesn't know what they are talking about (and this has happened before:) I only have to have my information sent from my lap band surgeon and have an upper GI and bloodwork and then when that is done call them to schedule an appt which is always Friday morning. I am a retired spouse who lived in sa five years ago but my lap band surgery was done in Austin. I hope this is going to hold up as far as what they have told me???? I have a call into the case mgmt dept to check that side after I saw your post. If this pans out the way I was told then I would guess each post/base has different criteria???

It has been frustrating because I bet I called tricare 7 to 8 times with them telling me I needed a referral before finally one of their reps told me how it worked which made sense. Then I called the bariatric office at Ft Sam and they kept telling me I needed a referral and try to get me off the phone but I hung on for the ride. I stopped her and said when you say referral you are talking insurance terminology and insurance doesn't have anything to do with this. I then said are you saying you need something like a letter with all my stats from my primary and yes that is what she meant but then when she finally understood it was a revision that all changed. I had already requested the info from my lap band surgeon and they already had that so she said I only needed the UPI and bloodwork????? Took about 3 weeks to get to this point....hahaha. Hopefully in the next 3 weeks I will get the email that says what bloodwork needs to be ordered and I can walk to my primary.(suppose to get it in the morning:). After 24 1/2 years as an Air Force wife And mother to 3 I had to learn patience and diligence because of rules and regulations that are numerous.

That's for your post!!!

[Elissa55 8]

Hi Char' date='

I am trying to get a revision surgery at Ft Sam in San Antonio-so far unless the bariatric surgery dept doesn't know what they are talking about (and this has happened before:) I only have to have my information sent from my lap band surgeon and have an upper GI and bloodwork and then when that is done call them to schedule an appt which is always Friday morning. I am a retired spouse who lived in sa five years ago but my lap band surgery was done in Austin. I hope this is going to hold up as far as what they have told me???? I have a call into the case mgmt dept to check that side after I saw your post. If this pans out the way I was told then I would guess each post/base has different criteria???

It has been frustrating because I bet I called tricare 7 to 8 times with them telling me I needed a referral before finally one of their reps told me how it worked which made sense. Then I called the bariatric office at Ft Sam and they kept telling me I needed a referral and try to get me off the phone but I hung on for the ride. I stopped her and said when you say referral you are talking insurance terminology and insurance doesn't have anything to do with this. I then said are you saying you need something like a letter with all my stats from my primary and yes that is what she meant but then when she finally understood it was a revision that all changed. I had already requested the info from my lap band surgeon and they already had that so she said I only needed the UPI and bloodwork????? Took about 3 weeks to get to this point....hahaha. Hopefully in the next 3 weeks I will get the email that says what bloodwork needs to be ordered and I can walk to my primary.(suppose to get it in the morning:). After 24 1/2 years as an Air Force wife And mother to 3 I had to learn patience and diligence because of rules and regulations that are numerous.

That's for your post!!![/quote']

That was suppose to say Thanks for your post:)