Tri-Care

[browneyes1997 0]

You know its funny that you say that about eating everything in site. I was complaining to my daughter about my "big clothes" not fitting and the fact that I was gaining and at the highest for me, and she looked at me and said, you are eating to much. You haven't been watching what you eat because you think you can get the lapband and if you weigh enough they will approve you. It was so true, but it made me mad at first. But sometimes even when the are 17 they come out with a true statement.

[JamieNP 20]

Well, I am figuring I won't ever be eating any of this crap ever again once I get my band. I just had my cholesterol check and it was good (shocking!!).

[LALINDSEY 0]

I have Tricare Prime, I was covered 100% I'm in Tennessee and you know they sayling everything is slow here... :thumbup:

I was banded 07-10-08.

I started the process in Feb 08.

Tricare said I had to be 100 pounds over weight with 2 comorbities

but the Surgeon on the other hand made me diet for 3 months..

before they would submitt it to tricare.

1. PCOS

2. Pre diabetic due to the Pcos

3. Didn't know it till I had the sleep study, Hello sleep apena.

4. knee problems...

Good luck everyone......

Lalindsey

[JenniLeen 0]

When I went to see my pcm he was totally ok with giving me a ref. but he said I should try to gain to make sure that I got approved. I ended up gaining about 15 pounds before my surgeon consult. Everything worked out well. It was actually hard to gain though. I had to eat A TON of food. It was horrible. But now I have been banded for a month and I love it. I haven't had one single issues.

oh and it took me about 2 months to get everything done too but that was because I couldnt get my records from my darn ob, so that was really irritating! But from submittal to approval to surgery it was less than 3 weeks!

[tutornmom 1]

I had been waiting for Tricare to approve this so when I saw the news at the end of March I made an appointment with my PCM. It was the 1st week of May and she didn't hesitate on the referral. I got it on the 18th and immediately completed the surgeons paperwork. I didn't hear back from them until the middle of June and by then the Nat Guard had messed up my DH active duty orders and thus our insurance had changed from prime to reserve select. I waited until the first of July hoping that the orders would be straightened out and no confusion would occur but they didn't so I made my appointment with the surgeon on 7/29 when we will still be Tricare standard. My nutrition appointment is 8/6. I should be Tricare Prime again in August but who knows with the way my DH orders are going. We have decided that I am going ahead whether we are Prime, standard, or reserve select. I was really trying to get this done during the summer because I teach but I don't think I am going to make it.

Essentially, I said all that to say that Tricare hasn't been the issue. It has been more of an issue with busy doctors and crazy orders.

Waiting in Alabama!

[JamieNP 20]

I think the issue of tricare denying is the doctor's offices. My doctor has quite a few tricare patients and deals with that insurance all of the time. I have been worried about getting approved, but today they said "oh, you will have no problem". Now I am just waiting on my psy test and my other tests and the submit to tricare.

[AZChick289 1]

I too am Tricare and was approved very quickly .. I wish though they were paying our Drs and hospitals more. Alot of places won't take Tricare becuase they don't pay .. When I saw what the Drs charged and what Tricare paid I was shocked.

Tricare Rocks but the Drs aren't going to take our insurance anymore if they don't come around a bit .

I love this new site ..Always felt Military is family ..We know what we are have and are going through .. Now we even have another band to hold us together..

[Insky67 2]

AZChick...my surgeon told me I was the last tricare patient she would see because they paid her and the hospital so little. I felt bad but am glad I got in when I did.

FYI...I was born and raised in AZ. What part are you in? I am a Tempe girl.

[Choromom 0]

AZ Chick,

You are oh, so right about the Tricare pay vs cost. My surgeon's partner told me that I would have to stay overnight, so that the bill for Tricare would come closer to his actual expense! It was still same day, but it is a shame that military families are put in this position with civilian providers.

The only consulation is that Medicare patients have the same issues, because the coverage is based off of those guidelines.

[AZChick289 1]

Choromom My Drs insurance person told me that medicare patients are on the bottom of the list and I guess they only do a quota ..So I am so blessed I got it done before they start dropping Tri Care..Kind of embarrassing to know what they pay our surgeouns .

Insky I am from CHandler now but noticed you are from TAmpa.. Would you believe I was raised in St. Pete .Haven't been back in years but love Florida and Arizona ...

[amandainsicily 0]

I was denied twice. Hired an attorney from obesitylaw.com. Finally was approved. I was on the line for weight, but had comorbidities. I was banded 5/21. Good luck!

[JamieNP 20]

Amanda, if you don't mind me asking, were you under the requirement even by one pound? or did you fall within the range? I am working on gaining the 6.5 lbs, but I want to make sure that is enough. If I fall in range and they deny me, I will go through obesity law.

[amandainsicily 0]

I was right on the line. BMI of 40. It depended on the time of the day. My understanding, is that there are no appeals, after third denial and you have to wait 90 days to start the whole process over. I may be wrong. Obesitylaw.com, charged me 450 dollars. I was banded on the 21st of May. For me, it was money well spent.

From my referral to my surgery was about 13 months. Haved you tried country ham(it is salt cured in the south.) I swell up like a blow fish!! Again, good luck. Let me know if you get approved.:cursing:

[armywife4life 0]

Well honestly i have read on this site people putting ankle weights on under their pants for the weigh in. Depending on how you feel about that it could be an option.

[MrsEOD_2004 0]

I didn't have an issue getting approved - my PCM was happy for me to get it done. I started the procedure at the end of March and got banded a week ago. I was todl the same thing about TriCare being pretty easty to get an approval through, I'm glad I decided to do it when I did.