Tricare approval VIBES please....

[dl2418 0]

So we submitted again and Tricare wanted radiological reports of arthritis. I am 100# overweight by the MetLife table for medium frame. I've been treated with Enbrel for psoriatic arthritis, have GERD, benign hypertension and thankfully radiological evidence of mild osteoarthritis. Letters from two doctors recommending Lap-band as the way to deal with these issues.

My husband is coming home from Iraq in a few months and I don't want to have to gain 10# just to meet the 200% overweight criteria.

Vibes I get approved please.

[karen_karen 0]

it matters all about your bmi

if your at 40 bmi you need to have one co morbity

if you are at 50 you dont need any

if your not at 40 bmi then i suggest you to make yourself weigh more at the doctors office. depending on how far you are from that and if its 10 lbs you should get away with having a full bladder and some heavy clothes and some weights maybe (lol) you might still have to gain a few lbs. but when your on your pre op diet you will lose it all.

[dl2418 0]

Thanks, Karen. However, with Tricare it's about being 100# overweight and two co-morbidities or being 200% above ideal body weight. My BMI is 40 but Tricare doesn't care about that.

I'm hoping now that they have the X-ray reports they requested, as well as everything else we submitted, it will be enough.

[bugginbri 0]

I think I had a very different experience than a lot of Tricare patients. I have a huge family history of diabetes and had Gestational Diabetes with my last pregnancy. I was 100 lbs overweight but had no co-morbidities that I am aware of. I had no problems getting approved. It took a few weeks to get a response and I underwent very little testing. There was no 6 mos pre-op diet (only 10 days) and I wasn't required to have a psych eval.

Good luck!

[mljalways 1]

Good luck vibes coming your way. I have tricare prime and had no problems with approval

[KOLaficionado 0]

It sounds like you meet their criteria and then some. You do have Prime right? Sounds like the run around to me. I got a surgery date a month after my consultation so hopefully the process will be smooth for you this time around!! (((((((((((Good Luck))))))))))))

[FarmGirl7 0]

Hey Dani :thumbup: I hope Tricare approves you soon! I know this has been a long road for you!

[dl2418 0]

It sounds like you meet their criteria and then some. You do have Prime right? Sounds like the run around to me. I got a surgery date a month after my consultation so hopefully the process will be smooth for you this time around!! (((((((((((Good Luck))))))))))))

I was Prime. But due to issues with my PCM and difficulty with access to appointments for the kids, we're now Standard. We pay more but it's so worth it.

MetLife minimum ideal body weight for my height is 115. I'm at 218, so "borderline" on the 100#. I think that's why they want the x-ray reports and not just the letters, office notes from my doctors. *sigh* Morbid obesity runs in my family and while I can't blame it all on genetics, two have already had gastric bypass and I'm trying to get it under control while I can....

[dl2418 0]

Hey Dani I hope Tricare approves you soon! I know this has been a long road for you!

Thanks! It was resubmitted 4/29 and is still showing as "Pending Review" although revision of gastric port and gastric band adjustment have been "approved". Figure that one out!

[CantB2noty 0]

I think you are definately getting the run around, because when I called Tricare to see if it was even worth my time, the lady said she didn't see a problem and my doctor said Tricare is one of the easiest approvals. I have a BMI of almost 46, probably need to lose 130 lbs and am one of the healthiest unhealthy people you've ever met because I also have no co-morbidities. However, my gramma has type 2 diabetes, my dad has high cholesterol. I keep telling my doc I don't have any health problems...YET.... and thats what he is gonna tell Tricare too, lol

Keep us posted... Good luck and good ju ju to you!

[dl2418 0]

Thanks for the vibes! However, I was denied, again.

[savannahsmommie 0]

I'm sorry. I am waiting to hear back from Triwest and nothing so far. Mine was submitted about two weeks ago. Nothing even showing pending. Eh!! You should appeal it and good luck!

[Babygirl_68 0]

Hi

Ask you doctor to do a sleep study to see if you have sleep apnea. Most of over weight people have it put don't know it. I was one of them. I you have it that better your chances in getting approved. I am tri-care prime. I was 100+ overweight, have astma, joint pain, and sleep apnea. What's one more test if it is going to put you one step closer to you goal of WLS. Good luck. Stay positive. Think happy thoughts.:thumbup: