Desperate and Despondent

HELP!

I am hoping someone can help me.

I need weight loss surgery -- lap bypass.  I had it 9 years ago.  I was doing great and working out hard.  Maybe I gained 15 pounds back.  Then I had a knee injury and had 2 surgeries.  I didn't exercise and ate crap. I'm terified of looking at the scale, but at 5'3, I believe I weigh around 225 if not more.  I am a size 18.

Well I am a blimp now and dont' have the same insurance I had before.  I have my husband's HMO, Tricare Prime.  My understanding is they DWCS (aka Don't Want to Cover Sh*t).  I went to my primary and he gave me a referral.  The only dr. in the area that did carry my insurance, stopped.

I called Tri-Care Prime AND went through their directory and they show ZERO providers.  I am not a woman of means but I MUST have this surgery.  Here are my questions to anyone who will listen:

1.  How do I get Tricare Prime to Cover
2.  What does it cost -- cash -- to get it done?  I am considering lapband or gastric bypass again.  I just know I want my life back.  
3.  We have crappy credit, but is it possible to finance this surgery?
4.  Could I buy PPO individual insurance if I had to and then get a new dr to agree that I need Weight loss surgery and have it done?

I need practical advice.  I have already had my initial blood work done and getting ready to get cardio check up. (The HMO covers all that.) Now I have to figure this out.  This is not really about vanity.  It's about my health.  Most of family has died in their 50's due to complications of obesity (high blood pressure, heart disease, etc.)

PLEASE PLEASE PLEASE help in any way you can.  Thank you.

Obese X 2 

Unfortunately I don't have any suggestions for you.  I have Kaiser, but maybe you should also post this in the insurance board as well. You might find someone who has Tricare there.

I wish you the best of luck.

My understanding is that individual insurance polices don't cover WLS.

I have Tricare Prime, and I love it. They approved me first time. Not sure where you are at, but there are surgeon's out here that take it.  For Tricare to pay, you have to be 100 lbs over weight with co-morbidities, or 200% over your ideal body weight. They use the MetLife table, medium frame http://www.halls.md/ideal-weight/met.htm to figure out the 200%. I have not had my surgery yet, its scheduled for September. So, so far have only had to pay a couple of co-pays and my surgeon's program fee of $750.

Hope this info helps you, and if you have more question, feel free to pm me.

Jaime

Between this and your more recent question about surgery in Mexico vs in the USA, my sense is that you have not figured out what to do, you just know that things are not as they should be and you want to do SOMETHING.
     I think before you get to sorting out what surgeons are covered here, whether or not to go to Mexico, etc., the most fundamental question to address is how to remedy the current situation. You have already had gastric bypass. It ain't working so well for you. You seem to be considering getting it redone, somehow, but you don't say that there is any technical problem with the operation you currently have. If it's still a proper gastric bypass, I don't understand how doing "gastric bypass again" is going to help you.
   I understand even less how lap band would help, as it is less effective and has a much higher failure rate than gastric bypass. There are some surgeons out there doing band over bypass, but results are unknown. Is that really the direction you want to go?
     I think, before you try to get insurance coverage, pick a surgeon, location, etc, you need to sort out what, if anything, is wrong with the operation you have already, and then figure out how to get better results. Please note that I'm not saying that you did anything wrong, I have no idea what the cause of your failure is, and I can tell you that over on the DS forum we see new people seeking revision from failed gastric bypass and failed lap band all the time. 
     You requested "practical advice". My practical advice is to having your gastric bypas studied to see if it's still as it should be. If not, that MAY help you get insurance coverage, depending on your policy. If the gastric bypass looks perfect, that would say, to me, that having "gastric bypass again" would be futile and you need to look at other options. 
    And regarding Mexico specifically, I very much doubt that this is a safe option for you, as you need revision surgery, which is more complex and more risky than the original operation, and there are less surgeons who do revisions. There are good surgeons in Mexico, but less for revisions, and you don't have the safeguards that you would have in the USA.

Larra

 Laura,

I am going to say this nicely.  Please do not contact me again.  You don't have any idea who I am, what I am about, how high-profile, etc.

In the scheme of it, it doesn't matter.  Please do not make contact again.

Thank you.

Wow.  You just blew off, most rudely and for no provocation whatsoever, one of the kindest, warmest, most caring people on OH.  Not only that, but she is a SURGEON, and one of the most knowledgeable people who could POSSIBLY have answered your question.  You're an idiot.

How "high-profile" you are?  That sounds like code for the color of your skin - I've never heard anyone else use that phrase.  What are you, some has-been, washed-up fat former actress?  You are "high-profile" but all you have is crappy Tricare HMO insurance?  Puh-leeze.

I've got news for you.  You have VERY few possible options - which Larra most KINDLY laid out for you.  You have a failed RNY.  Band over bypass doesn't work.  Stomaphyx doesn't work.  The ROSE procedure doesn't work.  Plication doesn't work.  And changing your failed proximal RNY to a distal or ERNY is likely to at best give you the worst parts of RNY and DS - too much restriction, leading you to eat crap like you've already been eating, plus severe malabsorption, leading to malnutrition and osteoporosis and chronic diarrhea and a miserable life.  Larra was trying to lead you to investigating your alternatives, which are very very few.  But you somehow read into the kind things she wrote, and spent probably a good 45 minutes of her valuable time writing - FOR NO OTHER REASON THAN TO HELP YOUR SORRY ASS - into something that OFFENDED you?? WTF??

You have Tricare - you're screwed.  You are a self-pay, and unless your "high-profile" self saved some money from what used to be your career, you aren't getting ANY surgery that is going to do you any damned good.  There is basically only one thing likely to work, and you're not going to learn it from Larra or me.

Please feel free to block me too - you deserve whatever you get from your ridiculous, pompous "high-profile" attitude.  "In the scheme of it, it doesn't matter" - either to me, or to what is going to happen to you.  You've already screwed yourself.

Well, besides Obese x 2, you might want to add Obtuse Cubed to your sig.

You have just alienated one of the two people (the other is Diana) who are ABSOLUTE PROS at working around insurance issues in the state of California.  Brilliant.

And, right before you decide to hit that BLOCK button for me you might want to know that:
1--I'm pretty good at fighting insurance companies, myself; and,
2--I'm on my way to block your ass and may beat you to it.

You might as well block Diana Cox and shoot off your right foot while you're on a roll.

Brilliant.

 This is harassment.  Leave me alone.

I will close my account.  One day I will tell my story with your notes included.

Be proud of yourselves.....It's easy to have a big set of balls online.

Buh bye.  I can't wait to read your high profile book.