New here. Tricare/Humana questions.

[jems 36]

Hiya. I am finally starting this process. I am 5'7" and weighed in at 264. I have tricare south/humana. I had been to a nutritionist last year and tried phentermine last year, but I was 20 ish pounds lighter. I don't know if that will count towards the 3 month supervised "diet". At the time I was eating 1300 calories a day and exercising 4 times a week for 45 minutes on my elliptical. Took me months to lose 15 lbs. As soon as I stopped the medication I gained it all back, plus some. Just so tired of the yoyo. Anyone recently have the roux en y (what I am hoping to have) through tricare south/humana? How was your experience? Should I see a surgeon before approval or wait for my doctor to submit my packet to the insurance? Any info is much appreciated. Thanks.

[smiley922 447]

Not sure about tricare, but I have humana thru the obamacare in GA, and I was approved for RNY, no diet length requirement, just a documented history of weight loss attempts. They approved in 2 weeks once I met my surgeons requirments

[jems 36]

Thanks, Smiley. I just didn't know if that would count because I wasn't in the morbidly obese category when I have documented fails.

[smiley922 447]

I had no documented history of weightloss attempts except the info I provided about 30 years of yoyo, Atkins, Liquid Protein, weight watchers, etc, weight highs and lows, and approximate time frames. He summarized it for yhe insurance company and that is what they went on, with my comorbid conditions

[jems 36]

Thanks again. was this your regular doctor or the surgeon? I'm trying to figure out if my doctor (who is over 6', weighs maybe 130, and doesn't seem to have any sympathy for obesity) is the one to do this or if I need to just talk to a bariatric surgeon who actually understands what is going on.

[smiley922 447]

My surgeon, who is very tough. Wont commit to do the surgery until you follow his plan, diet, food logs, moderate exercise, and doing all the necessary appointments and meetings. Also a multipage questionnaire, describing your history. That took about 3 months for me. I think that tough is better personally, I was honest about my past, up front about my struggles, and had lost 25 pounds before I ever saw him, then lost 20 more in the 3 month before he approved me and submitted to insurance. He also has no personal weight issues, but he takes your health very seriously, and wants to make sure you do also, so I stuck with him and followed what he said. . My son met him after my upper gi, and said if he is the one doing my surgery, then he was ok with it.

[jems 36]

That's awesome. Tough works. I have no problem with waiting 3, 6, or however long. Just as long as I know the process is getting started and in good hands. I was talking to my old doctor about this and the next step was surgery. Right when we got to that point, we moved (husband is military) now we are in a new area with only civilian doctors and it is just an adjustment for me. I told my new doctor everything that had happened, how much I eat, the nutritionist, exercise (which consists of my elliptical, ddpyoga, and other random activities) my new doctor just told me to walk and said nothing about surgery or giving my a consult to a bariatric surgeon. I personally think he is against WLS and won't submit anything to my insurance, that is why I was wondering who does what.