I need some ecouragement Please!!

I just went to the surgery information class at viquest in greenville today!!  It was very informative.  I learned so much there.  But i got really discouraged as to when they said they would need us to bring the past 5 years of weight history....i got married 3 years ago so i only have  the past 2 1/2 years of history but the doctor told me that tricare doesnt require that information so why do i need to bring it?  (did not have insurance prior to being married so did not go to the doc) and also i am really scared i will get denied due to that i have no comorbids but degenerative disc disease which they said today that some do not really consider that a comorbid...i am 5'4 at 256 with tricare insurance..i know i only started this journey so i really dont want to get discouraged already so please give me some courage in which i know that all of you have because you have been down this road or are this journey already.  sorry so long just needed to get it out...thanks to darcie and jamie for helping me as well amanda

HI Amanda :)
Your welcome!!!
LoL You've hit your FIRST of many speedbumps!
Tricare DOES require a 5 year weight history!! And also they want to know all of your past diet and exercise attempts. Did you go to weigh****chers or even step on a scale during the past 5 years before you were married??  If you did..submit those weights along with the ones from the doctors office since you have been married and I believe that will work, DONT quote me on it, but I read somewhere that they do accept a personal weight history journal. So as long as you stepped on the scale in the past 5 years and recordered or remember your weight, maybe you can write it down and have your dr. sign off on it! Don't worry if you don't get approved, get back up and dust yourself off and get ready for an appeal. BUT don't worry yet about not getting approved, you have a HUGE process of testing to go thru before it reaches Tricare and maybe they will find something
that may raise a red flag, ya never know! ALSO what is your BMI??? The higher the better *UH NOT REALLY...LOL* but for insurance purposes :) But you have completed the first step of your journey and that was the Orientation!! SO hang in there girl, it is way too soon to get down yet, you still have a long road to go! Keep your head high and think positive and keep reading the message boards...they are a heap of information to keep you knowledgeble. Okay so you think your posts are long...hahaha don't get me going, cuz i won't shut up

thank you jaimi my bmi is 43.9 so almost 44 is that better if its higher if i dont have any co morbids? thanks again and maybe they will consider my back disease as one who knows

Hi Amanda.  I don't know the specifics of Tricare, but with most insurances you must be over 40 BMI with or without comorbidities, or 35+ with comorbidities.  So at 43, you're over the usual limit.  As far as your weight history goes, each insurance varies, but a lot of them will take weigh****chers or anything like that.  As the post above says, try to find anything where you stepped on the scale in the last 5 years, just one for each year.  Was there a trip to the ER?  How about a GYN or other specialist?  Think hard, there might be more record of your weight than you think out there. Good luck with the approval process.  PCMH is a great place to have this surgery with several very competent doctors.  If you have any questions, feel free to email me. Take care. Ellen

Did you go to the OBGYN yearly? Did you ever go to the ER - think about anywhere you may have been weighed... doesnt have to be with a PCP. Do you have older medical records than 5 years you can get? I am not sure about the rules for tricare - I read the above post that said you do in fact need the 5 years so get whatever you can... all you can do is submit what you have and see what happens - sometimes you can send in pictures that show you were overweight to back up the lack of records - especially if you have been big since you were little :-) whatever you can do to show a history, no matter what, is better than nothing!

I honestly can not think of anywhere that i have been to be honest...i know i had a papsmear but cannot think for the life of me where it was it was back in texas so i couldnt tell you....i could not afford to do weigh****chers or jenny craig for i was a one income family i have done all the diet pills and exercise and my mom was on weigh****chers so she gave me her info and it did not work for me i am involved in a gym right now nothing helps...the doctor today stated that tricare did not require the documents but we will see i will just take the 3 years of history with me....thanks to all who are replying.

((((Amanda)))),

I imagine that they want you to bring in 5 years of medical records because that is part of their standard practice. Bring it what you have and go from there.

I wouldn't worry about not having a co-morbidity ... co-morbidities are things that can potentially shorten your life, so while the degenerative  disc disease really negatively impacts the quality of your life and may well factor into their decision because of the expense to treat it in the long term may be impacted by your "excessive" weight, it generally would not qualify as a comorbidity because it won't shorten your life like high cholesterol, hypertension, diabetes, or sleep apnea (to name a few co-morbidities) might.

The fact that you are 5'4" and weigh in at 256 puts you at a BMI of 44, which is well over the threshold for most insurers. Also the medically suggested ideal weight for someone your height is 121. At your current weight, you are well over 100 lbs over that weight. I believe that Tricare wants you to be at least 100 lbs over and you are 135 lbs over, so I believe that you'll meet their criteria.

You might want to cross-post your concerns to the main, rny and insurance forums too. You might well get someone else who has experience with Tricare that can give you more specific information.

I know that we are soooo easily discouraged at this point, but hang in there. You are going to do fine.

Barb

Thank you soo much for all your information....i did put it across the insurance board and i had no responses i had my first consultation scheduled for the 11th of march and it got moved to the 25th so that was a big dissappointment....i will just take to the doctor iverything that i have available and will go from there.....so i will keep my head up and stay positive..its hard i really dont have support here so i come here alot to get it...thank yall so much again

I'm in the same boat you're in..  I went years and years without going to a doctor. Before that I was an over the road truck driver!!  Back then, I only went to a doctor when something was wrong. I'm just calling the ones I can remember and asking them to fax everything to one particular nurse who will complie alll the data and send it to DUKE.  Kelly :)