Wish me luck....

IntoLess · May 16, 2008

I go Monday for my consults, then the insurance papers are filed! I have spent the last few weeks trying to prepare myself, but I am confused as to what to prepare myself for, let down because of insurance denial, or the joy of being accepted. My insurance is Tricare Prime, one of the easiest to be accepted for, but still have my doubts. I spent all day yesterday in my PCM's office getting seen for swelling in my ankles and knees. He is very supportive of me trying to get this surgery and an all around great man, he gave me some pain meds and steriods for the swelling (which I can't take until NEXT Thursday due to allergy testing), BUT anyway, back to my doctor, he said he had no doubt that my insurance would approve it, and my problems will no longer exist when I lose the weight.

I am so excited at the thought of having this great tool to help with my hard work and will definitely be let down if they deny me.

Keep me in your thoughts and prayers this weekend, and maybe as a group we can get me approved!

gina s. · May 16, 2008

I'll do it for you if you do it for me!!! I have Tricare Prime also, and I'm still waiting to hear if they approve surgery for me too. So hears wishing both of us luck!!!

IntoLess · May 16, 2008

Where are you stationed? I am hoping for the best for you! My PCM said yesterday that Tricare was approving them left and right, so hopefully we have a shot!

sirlsa · May 16, 2008

I have my consultation on Tuesday the 27th and I'm ready for a fight. I was denied two years ago and I did not question it. Since then I've tried fat blast and weigh watchers; I've decided to try again. I had UHC before but I'm not sure what plan I had, I still have UHC and I have the Choice Plan 100. Does anyone know if the process/approval process is as easy as Tri-Care Prime?

Also, my BMI is 35 and my only problem is orthoarthritis and walking is very painful. I've been on several types of med's for this and has taken shots to help with the pain. I don't know if this is enough for my insurance company. Any suggestions?

IntoLess · May 16, 2008

Talk to your insurance company and find out what their requirements are for approval. Every insurance company is different, then different policies within the company vary as well. Find out exactly what it will take to get approved, be direct, be persistent, and be nice.

gina s. · May 22, 2008

Where are you stationed? I am hoping for the best for you! My PCM said yesterday that Tricare was approving them left and right, so hopefully we have a shot!

I'm at Ft. Hood, but I'm going to Scott and White in Temple. I just found out today that my surgery was approved, so I'm really excited! All I have to do now is wait for a surgery date. I'll be hoping it goes as well for you!!!

IntoLess · May 22, 2008

I'm at Ft. Hood, but I'm going to Scott and White in Temple. I just found out today that my surgery was approved, so I'm really excited! All I have to do now is wait for a surgery date. I'll be hoping it goes as well for you!!!

We are at Hood too. I am going to Dr Ganta down in Austin. I started to go Temple, but I am so tired of driving there, my PCM is in Temple, and Austin has so much to offer as far as entertainment, so I am not going down for "just" an appointment. Plus, GolfSmith is down there, and my husband always needs an excuse to go to GolfSmith. My surgeon still hasn't put in my paperwork, so HOPEFULLY it will get done today----they said they would do it yesterday afternoon, but they ALSO said they would do it first thing Tuesday morning when I was there Monday......We shall see.

resintx · May 22, 2008

I live in Waco and I am trying to get my PCM here to refer me to Scott and White in Temple. I went to the seminar last Thursday, so now I have to wait to be refered. What conditions did Tricare put on the approval? I have some other medical problems that I need to get done first and hoping after that I can start the process of getting this done.

IntoLess · May 22, 2008

My PCM told me when they send it in for the consult, they have to put your weight, height, and BMI.

BUT when it comes to actually having the surgery approved, Tricare looks at how much you weigh and any comorbids (problems due to weight) that you have. They say on their website you need to be at least 100 lbs overweight and have at least one comorbid (diabetes, high blood pressure, osteoarthritis of the weight bearing joints, etc) OR be 200% over your recommended weight. Tricare uses the MetLife scale to determine this Met life ideal height weight tables references

Unless otherwise stated by your physician, everyone is considered to be medium build, so take that into consideration when looking at the chart.

That being said, I know a few that haven't been 100 lbs over who were approved, but a few that weren't 100 lbs over and denied. Also a few that met the criteria and needed to resubmit paperwork (maybe something was left out the first time????) to get approved. I am hearing that they are approving left and right here lately, so we shall see.

Rugrat682 · May 22, 2008

Good Luck! I am sure you will be fine as long as you meet the requirements. I have a different ins which I was told was good at approving as well. I stressed out soo much but got approved. I am sure you will be fine. Keep us posted.