Humana Tricare South Approved Today Georgia!!

[Jesusislove 26]

Hi, I am here in Atlanta Georgia, my Lap-band was just approved today by humana tricare south, we are prime. You need at least 2 co-mordbitites and 100lbs over, mine were HBP and Joint Pain. I am approved. I weigh 260, and I am 5' 9", do not give up. If you are 200% overweight, you need no co-morbs. My referral was put in Thursday approved Monday. I barely made it at 260 to be approved, 249 was my Metropolitan Life chart number. Anymore questions just reply.

Edited March 24, 2008 by LLPlady3

[rjohns26 0]

I live in the upstate of SC and am now waiting to go to a seminar on April 9th. Our tricare representative has given me the referral to go see an out of network doctor. After the seminar they will see if the hospital where he practices at will take Tricare. He is in Anderson, SC. I do not know if this will work out or not. I have tried to go to a network doctor here in Seneca who is in our network but he only practices at a hospital that is out of network and they won't do it there as they say they will lose too much money. Can I get the name of the doctor and hospital that you are using? I am really getting discouraged. I am ready to go out of state if I have too.

Thanks

Debra

[Jesusislove 26]

I am using Peachtree Surgical Associates, and they are tricare participating providers and they are a center of excellence. You emailed me about what I had to do, well I had to have a pulmonary clearance, a cardiology clearance including an EKG, A PCM letter of necessity. Nutrition eval and psych eval, tricare does not require neither eval, but the bariatric doctor might. I did all of this before seeing the doctor, this is what their center requires. From my understanding, you can see an out of state doctor as long as it is not too far away.

Edited March 25, 2008 by LLPlady3

[mommakatx2 0]

CONGRATS TO YOU!!!!

I am still waiting for everything to come together to my surgeon and be submitted to Tricare, but it's encouraging to hear of the approvals! I am 5'8" and 266. Can I ask, were you on meds for your BP? I have higher BP but my cardiologist said I don't need meds until my heart shows signs of enlargement. I wonder if Tricare will still consider that a comorbidity.

Anyway, congrats and good luck! Keep us updated!

[Jesusislove 26]

Hi, I was on meds 10 years ago HBP, came off, and my doctor put me back on them about a month ago. Did your doctor put this down as a co-morbidity, if so I would ask him for the prescription.

[windyacres_2000 1]

I have had these questions with Humana. Do they use the number at the bottom of the Met Life scale range? And they have told me I need six months physician supervised diet - if I lose below my current weight, will that disqualify me? I am right on the borderline to qualify.

[Jesusislove 26]

Hi, is this Humana Tricare or regular Humana? Humana Tricare does not require a six month physcian diet plan. They quoted you the wrong information. If you are border line and fall below the charts you will not be approved. Tricare goes strictly by the Metropolitan life chart. No supervised diet is needed. I would call them and speak to a supervisor.

[cmedwards 0]

Hi, I too live in Atlanta and am looking into the lap band and per your post you had a quick approval with Tricare Prime which I also have. Who was your surgeon? How did it go?

[windyacres_2000 1]

Regarding the Met Life scale - can you help with this? It shows a range of weight for my height. If I am 100 pounds over the bottom of the range, do I qualify?? Apparently we have a somewhat unique policy, terms set by the employer.

Thanks!

[windyacres_2000 1]

Hi, is this Humana Tricare or regular Humana? Humana Tricare does not require a six month physcian diet plan. They quoted you the wrong information. If you are border line and fall below the charts you will not be approved. Tricare goes strictly by the Metropolitan life chart. No supervised diet is needed. I would call them and speak to a supervisor.

I have Humana Preferred.

[windyacres_2000 1]

Hi, I am here in Atlanta Georgia, my Lap-band was just approved today by humana tricare south, we are prime. You need at least 2 co-mordbitites and 100lbs over, mine were HBP and Joint Pain. I am approved. I weigh 260, and I am 5' 9", do not give up. If you are 200% overweight, you need no co-morbs. My referral was put in Thursday approved Monday. I barely made it at 260 to be approved, 249 was my Metropolitan Life chart number. Anymore questions just reply.

Sorry for all the questions - you said you barely made it to be approved at 260 - did you doc say you had a large frame? That chart is so confusing!

[talkalot1981 5]

Ok, I am going through Tricare as well. I am 5'4" and weigh 249 and have hypertention. On the met life table I should be 124-138lbs. Tricare only goes by the bigger number. So in order for me to qualify I would have to be 238. I am over that. They also go by med body frame. Thats it. If you are 100 lbs over you need at least 1 co-morbity. Search tricares website and look it up. Or call tricare and ask. Thats what I had to do cause I got so many different responses from people that also have Tricare. Technically because I live in Alaska we actually have Triwest. I have never heard of Humana Tricare. I just came from North Carolina and we had Tricare North region there. But it is all still Tricare... Jennifer