Cry

[esskay77 785]

Wow! I completely forgot about my insurance issues--yes, call your insurance company but get it in writing!! They don't all know what they are talking about.

I was a consultant so bought my own insurance--BCBS. I was following everything that I needed to do for them. Insert my previous story here--started with one hospital program that was affiliated with my PCP, did all the tests, but then got pushed back because the social worker didn't think I was ready yet, etc. I was pissed off because she only met with me for like 2 minutes so I wasn't sure why she thought that. Anyway, I was so pissed off that I got more info and discovered they weren't the only game in town. So, I changed PCPs (to my old one anyway so we had a history) and she was very sympathetic to my story and got me into the surgeon that is affiliated with her practice. That surgeon was wonderful and was able to use the results from a lot of the tests from the previous place which kind of fast tracked me, though I still had to wait because she is the only surgeon at this hospital that does this surgery so she was booked. During this time, I had decided to go back to work full time. Because that could also mean different insurance I was a bit freaked out about how/when this could happen and tried to have the surgery BEFORE I started my new job. But, of course, that didn't happen.

So, I started my new job and during my first few weeks there when I needed to figure out which insurance plan I would use, (we had a choice of 2), I called both companies to find out if they covered WLS and what the scoop was. They both told me that the plan my company had chosen did not cover WLS so I was out of luck. I had tried to call our HR people to ask but they didn't know (they are outsourced) and just told me to look at the web site which didn't mention it as being covered or not being covered. So, I believed the insurance companies so opted to keep my BCBS and pay for it myself (which costs me about $600/month!!).

And, of course, I had the surgery within the next month which made me feel horrible for asking my boss for the time off to do this but he was fine with it.

Afterwards, I met several people in my new company that had the surgery as well and guess what? Yes, our insurance DOES cover it!! So for the next year, I still had to pay out $600/month on my own to keep BCBS since you can only opt in to the company plan once a year during their enrollment period.

The only good thing is that this company insurance would have made me start the whole process over again and they had a 6 month or more plan that you had to go through so maybe it worked out fine. But it did freak me out and make me very upset for a bit.

Ugh.

[zedqueen 27]

All I can say is support group support group support group. They help A LOT. Believe me darling. You'll be ok

[mal0712 101]

It can be a very difficult process and a confusing one. You can actually have your insurance company send you their policy regarding WLS coverage. This is what I ended up doing with my *** because you are absolutely right some representatives will give you different answers. It was a lengthy group of papers but the full policy was there in black and white. I was also able to secure a health care advocate through my insurance company. I have actually been fighting to get this surgery since 2008 and I finally had my RNY in May 2014. I met all the requirements and went through a few different medical groups until I found a doctor and specialists who were willing to support my need for the surgery.

I did have to go through the 6 month program in which I had to fulfill my insurance requirements but also my medical group requirements. At first I was a bit annoyed because I had become so studied in the surgeries. I had to drive down to meetings at least once a week which for me was a 3 hour round trip. But I learned and observed several different things from my teachers and fellow patients. I even took a 2 month psychology class which was awesome. I have lost 90 pounds post-surgery and have 10 more to go to meet my goal weight. I have gotten rid of several conditions and medications. I was also recently asked to be a representative for my University's Bariatric Program at an upcoming health event. I have really developed a passion for helping those going through the process. So if you need any encouragement or I can help answer any questions feel free to ask. You sound pretty determined and that is probably the best quality you can have right now. Keep that passion, keep pushing, don't give up...❤️

Tricare climb they do not have a full list for bariatric patients other than the little 2 paragraph one on the website :/. The doctor I'm seeing is about 2 1/2 hours away so I'm hoping they won't require too many trips. The financial part of all this scares me. My husband and I are raising 4 kids. We get by but not by much. I'm scared to death that they are gonna ask me to pay way more than I can and I will just be stuck in this body forever.... I cried the whole way home after meeting dr woodman because it was like I had so much hope there that this change would happen just to have it shot down because of how much money it was gonna take..... I'm just gonna hold out hope!!!

[mal0712 101]

Tricare climb they do not have a full list for bariatric patients other than the little 2 paragraph one on the website :/. The doctor I'm seeing is about 2 1/2 hours away so I'm hoping they won't require too many trips. The financial part of all this scares me. My husband and I are raising 4 kids. We get by but not by much. I'm scared to death that they are gonna ask me to pay way more than I can and I will just be stuck in this body forever.... I cried the whole way home after meeting dr woodman because it was like I had so much hope there that this change would happen just to have it shot down because of how much money it was gonna take..... I'm just gonna hold out hope!!!

Claims not climb lol

[mal0712 101]

I was told different insurance companies have different requirements. I'm on tricare prime south and they did require a medically supervised diet. I did one like two years ago and they accepted those records. The diet is 3 months. Then they wanted another three months of prep. I did all the nutrition, diet, exercise classes and had my evaluation. Now I have an update appointment next week and will schedule a surgery date. It's baby steps. They want you to mentally be able to handle the drastic life changes ahead. Just keep your patience and stay strong. And do your best. We all know your struggles and are here for you ????

See tricare reserve select is saying 6 months diet, but when I talk to other military wives who had it done, they said they didn't have to do a diet at all. One said she went to a military hospital and other than getting tests done she had no classes, no nutritionist etc. it just boggles my mind how different everyone's experience is with it I guess.

[bellabloom 2,467]

What insurance do you have? Online you can usually find the requirements if you narrow it down and know your exact insurance. Get started with your primary now regardless, that will put you ahead of the game. Oh and a word of advice on the downlow- if you have Aetna, you will want to weight in on your first weigh in as heavy as possible. I mean dress heavy, drink tons of Water before, eat a big meal- because if you don't lose on Aetna your screwed and weighing more from the beginning in Water weight ect will help you. I would stuff weights in my bra if I had Aetna. For real.

You do not want to let this ridiculous requirement ruin your chances!!

[mal0712 101]

I have tricare reserve select south which falls under humana. When you call they say 6 months of Jenny craig, weight watchers etc, are required but a length of time wasn't on the website:/ I have depression and sleep apnea. My blood pressure and sugar levels are ok. My bmi is 56 or 57%!!! I'm really hoping they don't give me a hard time

[HappygoSusan 296]

I have Tricare prime. I had the lap band placed by a civilian doctor. It slipped and I had it removed within 6 months. I now have the sleeve, which was done in a military treatment facility. In both cases, my first step was to go to my primary care physician and get a referral. That referral will get you seen by a bariatric surgeon. That surgeon will then walk you through the process of getting approved. With a BMI above forty, you should have no problem getting the referral. It will do you no good to worry about what may or may not be required of you, your best bet is to take the first step and get the referral. I'm sure you're getting different answers on this forum due to the fact that under the heading Tricare, you'll find many different sub categories in different regions. I had my first surgery in 2010 and there was no pre surgery diet required of me, nor the liquid diet prior to my surgery, I just gave a verbal accounting of my diet history. I don't know what the requirement is now, since much could of changed in five years. The second surgery was done in a MTF, and again, I had no pre surgery liquid diet required, but that was my medical treatment plan, your surgeon will go over yours with you.

Sorry for typing so much, when the most important thing to say us to take the FIRST step and contact your PCP, after you get the referral, your surgeon's office will walk you through the rest.

Susan

[esskay77 785]

For me, the fact that I had tried Weight Watchers and Jenny Craig (among others!) in the past was enough for them. That satisfied their requirements. I didn't have to prove that I did these, either. Probably because almost everyone has tried at least one of these programs! So, hopefully when you tell them that you have done these with varying degrees of success (lost weight, put it all back on and then some if you are like the rest of us), they won't make you do these for 6 months going forward. But it's hard to say. Every doctor is different and every insurance is different.

[mal0712 101]

I have Tricare prime. I had the lap band placed by a civilian doctor. It slipped and I had it removed within 6 months. I now have the sleeve, which was done in a military treatment facility. In both cases, my first step was to go to my primary care physician and get a referral. That referral will get you seen by a bariatric surgeon. That surgeon will then walk you through the process of getting approved. With a BMI above forty, you should have no problem getting the referral. It will do you no good to worry about what may or may not be required of you, your best bet is to take the first step and get the referral. I'm sure you're getting different answers on this forum due to the fact that under the heading Tricare, you'll find many different sub categories in different regions. I had my first surgery in 2010 and there was no pre surgery diet required of me, nor the liquid diet prior to my surgery, I just gave a verbal accounting of my diet history. I don't know what the requirement is now, since much could of changed in five years. The second surgery was done in a MTF, and again, I had no pre surgery liquid diet required, but that was my medical treatment plan, your surgeon will go over yours with you.

Sorry for typing so much, when the most important thing to say us to take the FIRST step and contact your PCP, after you get the referral, your surgeon's office will walk you through the rest.

Susan

I go see my pcp tomorrow, but with TCRS we don't have referrals. We go see who ever we want as long as they are listed on the website as in the network. I wanted to kinda find out all I could before I go see her so we can pull up and see what all counts as being done or not. The website says you have to show failed diets, but I have been over weight since 1st grade!! I've been on a lot of diets just none documented

[esskay77 785]

Try to see if verbally reporting that you did these diets is enough. If you can talk the talk, they will probably allow it. If you did weight watchers, did you do the points system? Or the other way of doing it? Can you talk about how you did it? They don't give you proof so I don't know what you would be expected to bring in for proof.

[HappygoSusan 296]

@@mal0712

Good luck with your PCP today. If you don't need a referral, go ahead and call the bariatric surgeon today. Fretting about what may or may not be required won't get you anywhere, talk to the surgeon and get the process started, then you will know for sure what is needed!

Susan

[allielee 263]

I hear you!! I had tricare and was a revision. They told me I had to gain 50 pounds to have the revision from band to bypass (my band eroded) so I gained the weight. Then they said I had to gain another 25. I was a frigging mess! I had worked so hard to lose all my weight with the band to be told I had to gain 75 to have the revision is crazy. My husband praise God knew what it was doing to me mentally.. We ended up just paying the $30,000 out of pocket.. His take is he will get a lot more mileage out of me and my happiness than a new car will.. ???? so I am sitting here 8 months out from my revision with only 3 pounds left to a normal BMI. My BMI pre lapband was 47. Tricare can suck it lol. Good luck and hang in there!!!

[mal0712 101]

I'm gonna have to use tricare. If self pay was an option I would definitely do that!!!!! I was told they will cover the Tummy Tuck and breathe augmentation if medically necessary so I'm hoping all this will go in my favor