Tricare Approval

I'm 5'4" and 245 lbs with a BMI of 42, my doctor submitted my paperwork on last Friday and I was declined today. They said they needed more documentation, and that I dont have the comorbs that I need. I thought that as long as my BMI was 40, I didn't have to have comorbs, but it sounds like they are still using the 200% rule.

The Metropolitan weight chart leaves so much to guess at, Small frame is 114-127, so 200% would be 228 and medium is 124-138 or 248. I'm kind of inbetween a small and medium frame, my fingers do overlap slightly around my wrist.  Do I really have to gain 3 lbs and then have them resubmit the paperwork?

5' 4"

114-127

124-138

When I had my surgery you had to be at least 100 lbs overweight and have at least 1 comorb, maybe your regular Dr can re submit or your surgeon. My Dr knew what they wanted and filled   in the blanks accordingly, so to speak.Put something heavy in your pockets if need be, ankle weights??, LOL Make sure your Dr knows all they need to accept you.  I hope it all works out. Good luck.

tricare prime overseas uses 100 lbs overweight and 1 co morbidity, or 200% overweight. they do use the Metropolitan life insurance weight chart, and will assume medium build unless otherwise stated. My com morbidity was arthritis in weight bearing joint, my knees. my PCP did not want to write that in the paperwork for me, because he insisted that was not considered a co morbidity. I took the paperwork he gave me, along with a print out of my medical records where he had diagnosed the arthritis, to my tricare rep and had them submit that paper work. Also, check with your tricare rep and see what needs to be submitted. Here, the doctor has to submit some information online, but there is also a appendix that has to be submitted that documents that you have been to a Psych eval, seen a nutritionist, and some other things. Maybe that is what you are missing, because there is more documentation that is needed other than your height, weight, and co morbidities.

I didn't need a psych eval and a nut visit to get tricare approved, my BMI was 41.3 and I had slightly elevated BP and cholersterol. I guess tricare is not very consistent.. How are you doing? Are you healing? Are you going to try the band again?

Petra

I am doing well.  Got a new referral to a different surgeon, for evaluation.  I am anxious to ask about the fact the Prof Weiner found a slight hiatal hernia, but did not correct it before lap band.  I am hoping that is why my first one slipped, and it can be corrected and the lap band replaced. 
I did not need a psych eval when i first tried for WLS in 2007/08, but now they have some appendix that your PCP fills out, and and is physcially taken over to tricare, first time I tried and was denied, it was just a computer entry.  Hope all is well with you.  Wish I were in florida enjoying some sunshine.  we got more snow today, even though the temp is 37F.  I am ready for spring.

So much for best surgeon ever!!
Here it's 76 today into 80's by weekend.
Not rubbing it in :)) I'll yearn for low temps soon enough..Summer here sucks.  We just had friends here from Germany, we have decided that next summer we're gonna spend a few weeks in Germany. We have a party to go to on the 25th of May 2012 :))


Good luck with your next effort
Petra

I love hot, humid summers, mainly because everyplace and everycar is airconditioned in the states.  never have to be in the heat long enough to  notice it.  I missed the hot part of summer in Germany last year.  I believe my husband said it got as hot as NC, but no air conditioning.  April and May are wonderful here.  I look forward every year to the cafes setting up their outside tables and drinking coffee while watching everybody walk by.  My husband looks forward to how little the dresses get and how high the heels get on all the german women.  I will never understand how ya'll manage the high heels on the cobble stones.

I'm more the Harley riding kinda woman, hi-heels never have been my thing :) But I know what you mean. I used to crack up when GI's got arrested or shoo'd away staring at topless women in parks :)'
There's something about seasons..I guess that's what  I miss the most here. :)

Spring will spring,,,sooner or later, I have seen snow on easter,,,You have Fasxhing to look forward to next week, try to make it to a parade or a party you'll love it :)
Maybe you can make it to Mainz or Frankfurt for a big one :)


Cologne is a huge one as well but is too far away

Petra