Question about Tri Care Standard and WLS

[mel_smiddy 0]

I have several questions that I'm hoping someone can help me with.

I have Tri Care standard and I am in the North region. I am 110 pounds over what I should ideally weigh and have a BMI of 47.5. I am prediabetic. I have urine incontinence problems. Pain in my back, feet, legs and ankles.

1) Do you think I will be able get approval for lap band?

2) How long does it normally take?

3) Is there a 6 month supervised diet required?

4) About how much of a percentage of the total cost of the surgery did you have to pay?

Thanks for any and all responses.

BTW I went WLS seminar yesterday.

Melody

[mel_smiddy 0]

Is there anyone out there that can help ?????

[CarolinaGirl 0]

Mel- I am also beginning my journey in this and am in the North Region on Tricare Standard. The tricky part for me is that I have Aetna Choice POS II as my primary insurance and Tricare Standard is my husband's and is secondary. My company did not choose the bariatric coverage on our Aetna plan, so I am shooting for Tricare to cover. PLEASE let me know if you get any info and I'll do the same. My email is webb8992@yahoo.com and I am in Chesapeake,VA

[mel_smiddy 0]

I will definately let you know as soon as I know something. According to the WLS seminar speaker I should know in 10 to 15 working days if they can do the surgery or not for me. Lady said that it could be sooner because they have been getting pretty fast at approvals. CarolinaGirl please feel free to email me melodysmiddy@hotmail.com

[hopefulebndr 0]

I believe you will.. I just went at 5'6" and 262, so I barely made the 200% with no comorbids necessary, at your BMI I suspect you should be at the 200% as well. Don't know if TriCare actually requires it but I have to get psch eval (dr's requirement), cardiac stress test (Dr/anesthesiolgist req), thyroid test (dr. req), attend a nutrition class (dr. req), primary care dr ok/statement of mecially necessity (that was Dr req I believe), a letter from me, a letter from my spouse, my own DIET list from the past. I have asthma, lower back/disc problems, and fibromyalgia,and acid reflux - but I don't think I needed co-morbids as my 200% was enough for tricare. I don't believe tri care requires a medically supervised and/or 6 month diet requirement. I have tri care reserve select South - which is like tri care standard and my dr's are in-network, and from what I undersand I only have my small co-pays for everthing.

[CarolinaGirl 0]

Thanks for the info! I will definitely keep everyone posted and please do the same!

[mel_smiddy 0]

Thanks for the encouragement I really appreciate it unfortunately for me none of my doctors are in network there isn't even a medical treatement facility near me so I'm going to have to pay more than if it was in network. I have about $2500 cash for the cost of my part I'm hoping that it will be enough if not I'll have to borrow from my parents and I really don't want to do that. I have an appointment with my primary care doctor 2/14/08 to get a referal from him I'm trying to gain a couple more pounds just to make sure that I make the 200% mark. I know that sounds crazy but I am that desperate to get this done.

[minpinmom 2]

It might be worth traveling (money wise) to a surgeon in network. That seems like a lot of money out of pocket, you could drive or fly somewhere and stay in a hotel for a lot less, my surgeon gives free hotel rooms for patients coming in from out of town. Just a thought.

Oh, and I am 200% with no co-morbidities and I didn't have to do anything but submit a letter from the surgeon for Medical necessity. Although, a lot of the Dr.s require all that stuff, the tests and such, but Tricare didn't

Also, what is your height? You may have said already, I skimmed the responses pretty quick.

[mel_smiddy 0]

sorry I don't know if I said my height. I am 4 ft 9 1/2 inches and weigh 218 currently. I would love to be able to save some money on the surgery but I don't know where I would be able to find an in network doctor that would be close enough for me. Any ideas would be great. I don't suppose I would mind a bit of travel but I don't know where I could go.

[minpinmom 2]

For 4'10" for small frame (just hope the Dr. says you are small frame)

Here is Metlife's website, it is what Tricare goes off of.

Met life ideal height weight tables references

Met Lifes ideal height/weight for 4' 10" is 102/111. Tricare says you have to be 200% on both the low and high end, so:

low end 102 X 200% = 204

high end 111 X 200% = 222

If you are 218, I would wear layered clothes, heavy shoes, even weights on my ankles if I had to, then you wouldn't have to worry about any co-morbidities.

As far as Dr.s - how far are you willing to travel, do you want to drive or fly?

[mel_smiddy 0]

I suppose I would prefer driving. I'm not much for flying. I wonder I have already submitted my paperwork to the doctor and put 118 lbs on it maybe I can convince them that I was going by an old weight and that I had not weighed in a long time? I can gain weight in no time it isn't a problem.

[minpinmom 2]

Where are you located, and yes, before the dr. submits, I would try to have it changed. We can see what area to look at, I am sure someone will know a good Dr. within driving distance. I am in Texas, so I am used to driving.

[mel_smiddy 0]

I am located in Corbin,KY it is in the South Eastern corner of Kentucky

[minpinmom 2]

Here are a couple of thing that may help you find a Dr. in your area. First, if you look in the upper right corner of your screen (on the blue bar) use the quick search bar and put in Kentucky Dr.s or Kentucky banders, anything having to do with your area or dr.s in your area. It will search Lapband Talk for you. I did a search for Kentucky Dr.s and here were the first 4 threads, they mention Drs in your area.

http://www.lapbandtalk.com/f11/does-anyone-know-anything-about-dr-kaza-kentucky-50474/

http://www.lapbandtalk.com/f38/ohio-some-parts-kentucky-27091/

http://www.lapbandtalk.com/f18/lap-band-kentucky-49740/

http://www.lapbandtalk.com/f11/dr-argotee-paducah-kentucky-20706/

http://www.lapbandtalk.com/f38/just-saying-hi-ky-46661/

Then, write down the Dr.s names and search them on Tricare's online physician finder to see if they are in network.

I would also, check the forum for local Kentucky people - they may be able to tell you. Your other option (scary one) is call Tricare and have them give you a list of Bariatric surgeons within 400 miles or so, they aren't much help, but you can try.

Hopefully this will help narrow down your search. Like I said, you could fly to Houston, have the surgery with My Dr. for a 12 copay, stay the night in the hospital, then the surgeon will pay for your Hotel (not sure how many days) I am pretty sure this is pretty common practice, so it probably wouldn't matter who you went to as long as it was a Tricare surgeon, they would probably provide you with a Hotel. (I AM NOT PUSHING MY DR.) I can't stand when people do that on here, but you can look up his website and see how many days they pay for and such. Texas Laparoscopy Center

[dallman 0]

I have blue cross and tricare standard. My blue cross has a wls exclusion. They had to get blue cross to disaprove the surgery and then filed the tricare will let you know what the cost was when i get the bills. Send me a email so i will remember. I used Dr Morton at Baptist Hospital in Nashville Tn. I do not think it will cost much more than 2000.00 hopefully less. This doctor and hospital is not in the tricare network but is one of the centers of excellance. This doctor has done more than 1300 lapbands and experience drove me to him. Mini I am reading a lot but not posting much I am happy that you got approved. I have my first fill on the 18th of Feb and can't wait. I have reverted to a Atkins style of eating to keep from being so hungry. But is all good I am back to swimming 1/2 mile everyday and lifting weights everyother day.

Don