Tricare Approval or Denial??

[drhodes757 0]

Hi all, I have spent about a month now researching and doing all the necessary steps to get the lapband. Found out today that I need proof of not being a drug addict or alcoholic. Has anyone else faced that problem, and if so how do I prove something like that. Even my doctors office were confused by that question. I am a nurse and have to have periodic drug checks, do you think that would be sufficient for Tricare?

Never done drugs, and have about 4 glasses of wine a month.

Would love to hear from someone who went through the same stuff.

[AlaskaGirl77 0]

My process was as follows with Tricare:

Told my PCM that I wanted a referell,1 week later i had an appt. with a surgeon for that week. Flew down to Anchorage (we are in Fairbanks),met with him,got info flew home same day.

Waited 2 weeks for appts for xrays,bloodwork ect. Sent paperwork to surgeon and a week later Tricare approved me (Last Friday) and I fly down on the 22nd of May with a surgery date of May 26)...so all in all took less than 2 months from the time i decided till my actual surgery;.

[lisw55 0]

Hi all, I have spent about a month now researching and doing all the necessary steps to get the lapband. Found out today that I need proof of not being a drug addict or alcoholic. Has anyone else faced that problem, and if so how do I prove something like that. Even my doctors office were confused by that question. I am a nurse and have to have periodic drug checks, do you think that would be sufficient for Tricare?

Never done drugs, and have about 4 glasses of wine a month.

Would love to hear from someone who went through the same stuff.

Drhodes,

Do you live near a military installation? If so, you could contact the Drug and Alcohol Program. I believe they would be more than willing to write up a statement for Tricare to indicate you are not an abuser. They may want to do a brief assessment, but having worked with these folks for many years they might enjoy helping you. It's just a thought. Take care

[Amy Stew 0]

I am just now starting my journey. I went to a seminar with my neighbor kinda just looking into it and it was so eye opening to me.

I am 4''10' and 210lbs. right now. My BMI is 44 as of right now. I am 22 and will be 23 in June. For Tricare the nurse at the surgical center said I would need to be 218 to be approved with out co-morbids. Since they don't go by BMI, but by weight. My ideal is 110lbs. for height. I have had moderately high blood pressure, but no meds, asthma, and I did have thyroid itis for 5 months a few yrs ago that made me gaint 50 lbs. I have tried everything my Dr. has told me to do. I went to the HAWC had an exercise program...everything. My family has a history of extreme obesity, high bp, cholesterol.

I am going to gain back the 5 lbs i just lost and go for it. I am young and I do not enjoy life because of my weight. I am in pain at night if I go out and have a nice day outside and I just don't see myself loosing this weight because my parent never have. They say since I have the insurance I should definitely get the lap band done, so that I can better myself health wise and have a brighter future.

Do you all think I will be approved?

I just want you all to know my bp was sky high yesterday at my appt. and now I am on BP meds.

[kinseeker 0]

I need to know more about the five year weight history. I was told that tri-care needs a five year weight history. I don't have a weight record for every year only three of the last five. I do have pictures all the way back to 2001 showing that I'm overweight. I also have a strong family history of heart disease and diabetes. Has anyone been approves without the five year weigh history? I have tricare reserve select.

[AlaskaGirl77 0]

My five year weight history wasn't anything "official". Just me stating I did weight watchers in 2001 for 9 months,lost 60 lbs. Then regained in approx.5 months. Then 2002 I tried Atkins lost A amount of lbs. regaind B amount...ect...tricare was fine with that in my case.

[kinseeker 0]

AlaskaGirl77 do you have ticare prime, select, or standard? I heard that each one ask for different things.

[AlaskaGirl77 0]

We have tricare Prime

[RhiettaP 0]

I just started the process.....I am going to have to gain weight in order to get approved- how lame is that...gain weight just to loose weight?! I'm 5'4 and roughly 210-220 depending on the scale I'm on....I'm diabetic (controlled by diet) had gestational diabetes 2x now....I went to see my PCM and told him to either give me a referral or that I'm going to Mexico...he didn't want to give me a referral...told me to go on a diet...really?!? I've been on a diet the last 30 years of my life...if it was that easy...we'd all be healthy and thin! I actually see the surgeon for my initial consult on 18-Jun...so I've got roughly a month to gain...30+lbs? Do you think they'd notice if I got on the scale with bricks in my pockets;)

[drhodes757 0]

I just found out that I was denied for the lapband surgery..I am so upset. I didnt weigh enough, but I have decided to appeal this decision, as my doctor had put in the wrong blood pressure, so I am going back to my pcp and getting proof that my BP is borderline high.

I weighed 249 on my initial weigh in, and according to tricare themselves I should weigh between 133-144 due to my height, so technically I am 100lbs overweight.

If anyone has gone through the appeal process or have any suggestions, I would love to hear.

Thanks

[Ready4a2ndChance 0]

I'm so frustrated i'm almost ready to give up on the process. This is taking so long and hard to find daycare for my 2 kids while my husband is in Afghanistan..........These are the steps I have to complete:

PCM, get referral (completed)

see surgeon for consult (completed)

Dietician Appt. #1 (Completed)

Dietician Appt. #2

Nutritional counseling #1

Nutritional counseling #2

EKG (completed)

Chest X-Ray

H.Pylori Blood test(completed)

2nd Surgeon consult

wait for referral to come back

then surgery, hopefully

I still have 5 more things to do, and they don't have anywhere near me that does it so I have to drive to Wilmington, NC to go to these appts. and get these things done....thats a 2hr roundtrip on top of my appt. so it's like a 4hr ordeal almost each time.

They better approve me after all this aggravation............gas is NOT cheap.

[talkalot1981 5]

Ready- Is willington the closest surgeon? I assume you are at Bragg. If not sorry for the rambling. We just came from there. Have you asked Tricare to submit request for a closer surgeon? Plus alot of that stuff you should get to have on post at the hospital or your doc office. I did everything on post. I had a friend from up in Northern Alaska at Wainwright that got to claim TDY for coming here to Anchorage to have surgery because there was no surgeon in her area. Granted Wainwright is about 4 1/2 hours from here but still. Not sure if there is a surgeon in Fayetteville or not. You can go to www.lapband.com and find out. If so call Tricare and see if you can switch to one of them. I was approved to see a certain surgeon but didn't much care for him so they approved me to see an out of network provider. I hope this helps, if you have anymore questions feel free to ask. Jennifer

[Ready4a2ndChance 0]

we are in camp lejeune............and greenville, and wilmington are the only two places that have practicing surgeons for this surgery. They didnt' have any openings for me on base to be seen at the naval clinic, i'm sure that has to do with us not living on base since we bought a house. I am being seen out in town so I can't do my stuff on base, and the base doesn't have a nutrional counselor or dietician that is familiar with the pre and post op diet for lap band patients. My insurance is the normal I was referred to a pcm out in town because there was no room for me at the NHCCL................so i'm stuck. My surgeon works with specific dieticians that are in his clinic and the Chrysalis Center primarily for counselling so I guess these are my only options.............it just SUCKS, lol but i'll be happy after surgery

[Abbey M. 69]

:confused:hey everyone. i had a question about lap band surgery. I just left my PCM's office this morning and he has referred me to Swedish medical center for a weight loss surgery consult. I had a question about getting Triwest to pay for the surgery. I am 5'3 and a 1/2 and weigh 241lbs. my BMI is 42.4. SCARY I KNOW!! I have looked at the TRIWEST website several times and just cant figure some things out and cant get any answers from docs, tricare reps or even the surgery center where i was referred. so i logged on here and am hoping someone can help. Ok so here goes...tricare requires 100lbs over ideal weight with atleast 1 co-morbid OR 200% or more over ideal body weight. The ideal body weight for my height according to the metlife chart is 121-135. First.....do they calculate you being 200% or more over ideal weight by the first number (121) or the second number (135). Second....I do have high blood pressure which constitutes a co-morbid as well as asthma (not sure if that is a co-morbid or not). But I am not taking blood pressure meds for my high blood pressure. so my questions are those that i named and also....has anyone had experience with triwest and had a similar situation? what is the likely hood that I will get approved? if anyone can help i would greatly appreciate it!

Thanks!!

[talkalot1981 5]

Brooke- I am also going through Triwest. I am now waiting on my approval from Tricare. They go by the biggest number on the metlife tables. I am 5'4" and weight 249, so I am 100 lbs over weight. I also have High Blood pressure but my doc put me on meds so I will have proof of the co-morbity. I would suggest you have him put you on meds. If I were you I would jusr say you are 5'3" cause they might up you to 5'4" They didn't even measure me. I wish I would have known that cause I probably would have told them I was 5'2" LOL Anyway, hope this helps and if you have anymore questions please let me know...Jennifer