Tricare - ? regarding wt. and co-morbidities

[dl2418 0]

Has anyone who has been banded through Tricare (Triwest) been approved for the surgery without hypertension or diabetes as comorbidities?

I am 100lbs overweight with a BMI just over 40%. But I do not have high blood pressure, diabetes, or high cholesterol (as far as I know...waiting on lab results). My TSH/T-4 levels are also WNL.

The only health issues I can really relate to being a fatty are depression, shortness of breath with moderate exertion (stairs kill me), and some acid reflux. But only the depression is documented. The other stuff I just deal with and/or treat with over the counter medications.

I recieved the referral to see a bariatric surgeon and I am attending the required seminar next weekend. I am just so worried about being denied because I don't have HTN, DMI or II, hypthyroid, or hyperlipidemia.

I've tried weight watchers, thedailyplate.com, increased exercise with Portion Control, and phentermine. The only one I've had any success with is phentermine but it caused my blood pressure to increase and chest pain, which was no longer a healthy way to lose weight. There's also been lipovoxx, avakar, and alli that have also failed. I can only seem to lose 10 pounds before hitting a plateau I can't get around and then gaining it back.

So....just wondering if anyone else had been approved without the "traditional" comorbidities.

[amonroy 0]

I have tricare also and was banded in July, I did have some co-morbitites but when checking on coverage if you are above a certain BMI and I think it was 35 you didn't have to have co-morbities. You should give tricare a call to clarify because I cant remember the exact BMI. I believe I had a 41 BMI and approval process was very smooth. Good Luck with everything!

[RestlessMonkey 7]

I agree, call Tricare and ask.

[karen_karen 0]

ok im not suggesting this but i will tell you a story not saying it true or anthing. there is a girl that was about 100 lbs overweight without any co-morbidities and had tricare for insurance. for a month she went into her pcm weekly to get her blood pressure check right after she smoke a few cigarettes. she ended up with high blood pressure and hypertension since she "shakes" alot when she dont eat. well since her doctor diagnose her for hypertension and high blood pressure she got approved for the lapband. now she was first denied because she didnt have any co-morbitdities. so for her second try she wrote a letter explaining her co-morbidities and also how her life was effected with obesity. and wouldnt you know it after two to three weeks sending in that letter to tricare and doctors notes and letters and referrals from the pcm. she got approved. she was banded less then a month after that. no you can take this story the way you would like.

[Mrs. Bubba 0]

I am a Tricare person. My request was sent to them on a Tuesday, they received it on Wednesday and by 1:00 that afternoon I had my call with their approval. I have no medical problems at all, but my BMI was 58.8............. I can't say for sure what will happen to you... I think it is looked at by someone who makes the decision based on your specific circumstance. We are on the "Retiree" program and haven't had Tricare long, so I'm just learning, but I was treated very well. They called my that day and then asked if they could call after the surgery. They did call after I got home and the nurse was very pleasant and supportive. I hope you have a similar response. It helps to feel like you are being treated respectfully..... Good luck.......... Julie

[dl2418 0]

Well, I had recieved the prior authorization to see the surgeon, but I'm not sure that means that I've actually been approved for the surgery.

I'm sure I'll learn more next weekend at the seminar. I'll recieve my paperwork then as well so that I can schedule an actual appointment with the surgeon.

[coopswife74 0]

Please keep us updated. I would like to know what happens with your approval. I have Triwest as well, and just started looking into the LapBand procedure. Good Luck!

[dl2418 0]

I'll do my best to keep everyone updated.

[cobrien78 0]

I have triwest prime. I got approved for surgery in August and my surgery will be in November. I am 5'8 252lbs at initial consult w/ surgeon. My BMI was 38. The only documented co-morb. I had was PCOS w/ insulin resistance. I was approved in 2 days. It never hurts to try. Good luck!

[JenniLeen 0]

I was tricare prime and got approved with no co-morbs. good luck and keep us posted!!

[Scorpio81 2]

I have Tricare also. Right now I am waiting on my reply from them. I got the phone call this afternoon from the Nutritionist and am going in next week for that.

If I go ahead and attend a seminar now do you think that would speed the process along? I am hoping so.

My BMI is 47.1, and my doctor said that I was a candidate for the LapBand. My fingers are crossed!

[JenniLeen 0]

the seminar is just going to help speed things up with your surgeon. Tricare doesn't require that you go to the seminar, at least I didnt have to go.

[Scorpio81 2]

Thanks! There is actually one this Thursday only a few miles from my house, so I think I might go anyways. (There aren't anymore until November, and anything that will speed the process along is good with me!)

I can't wait. I hope it doesn't take forever to get this done!

[dl2418 0]

The seminar is a requirement of the surgeon I will be seeing, not Tricare. I will recieve the paperwork at the seminar, once that is complete, I can schedule my consult and go from there.