Help !!! I see my PCP for the first time next week!!! I am terriffied!!!!

Hi, My name is Jaye Jaye. I recently called Tricare and talked at length with a representative about having a gastirc bypass surgery, and what I would need to do to start the process. I gave her a brief description of my weight and health issues. I am 33 years old , I weigh 260 pounds and I am 5'7. I belive that I meet the requirments necessary to get Tricare to approve. The representative sounded like it should not be much of a problem to get approved. She told me to start my calling my PCP and setting up an inital consulation. She said that my PCP would feel out appropriate paper work, and send end to Tricare to see if surgery would be approved. She said that most claims ...as long as you meet the criteria was fairly easy for approval. I called and set up an appointment for April 17th (tuesday). This coming week. I have thought and thought about the surgery for two years now. I have read the various articles, watched it be done, and I know that it will be a long road; but I want the surgery so bad. I am sooo scared I am going to mess up the meeting. What exactly happens at the first consulation? What should I say or not Say? I really don't know what to expect, and it's something I want !!! PLEASE PLEASe can anyone help me? Any advice would be appreciated!

Hi Jaye! When I went to my PCP and I told him what I was there for. I told him my BMI and of course he knew of my medical conditions. He thought it was a good option so he referred me to Dr Byrne at MUSC. Later I received a package in the mail from MUSC and had to go back to my PCP for a EKG and a physical and letter of recommendation to send along with the other paperwork I had to fill out. I sent it back in and then MUSC called and told me about the WLS class to go to and set my appt. with Dr. Byrne. It isn't a fast process. I don't have my consultation with the surgeon until May 24th. I am anxiously waiting though! Good luck on your adventure! hugs, Teresa

I was lucky that I didn't have to have my PCP approve anything, he wasn't too thrilled when I even mentioned it to him. All he said was I wasn't big enough to have it done, lol, yeah right, I am 5'3'' and weighed 247.8 at my highest. Thats more than big enough ,plus all the co-morbidites that I had more than qualified me for GB. I just went to get my new prescriptions for this year and he was surprized at my weight loss and wanted to know what I did to lose it , since everything he has done to help me over the years has failed. I told him I did exactly what he said not to do, the GB, he didn't say anything for several minutes then asked how bad was it and did I have any problems. I told him the surgery wasn't bad at all and I had no problems, everything was going good, and that he needs to stop being so narrow minded and reccomend it to others if they have problems losing weight. I don't know what your insurance requires, but, I'm sure you will qualify as long as your BMI is over 40 without medical problems and 35 with them. Just answer any questions he asks you and I'm sure everything will be fine. Good luck and best wishes for taking that first step toward better health. Hugs! Mary

hi there I have tricare also it was not bad at all just see your PCM & they will send in paper work & you will go from there it is simple just alot of stuff you need to do when you are approved good luck

WELCOME TO THE BOARD ... AS LONG AS YOU HAVE TRI CARE PRIME (not Standard), THE PROCESS TO GET APPROVED FOR GASTRIC BYPASS IS FAIRLY EASY. BMI OF 40 OR MORE ... 80 TO 100 #s OR MORE OVERWEIGHT ... CO-MORBS (weight-associated medical problems) ... GET AN "EVAL & TREAT" REFERRAL FROM YOUR PCM/PCP TO A GASTRIC BYPASS SURGEON ... GET A LETTER OF MEDICAL NECESSITY FROM YOUR PCM/PCP ... FILL OUT A TON OF PAPERWORK ... EASY MEDIAL & SIMPLE PHYCH EXAM ... &, YOU'RE IN. READ MY PROFILE ... I HAVE TRI CARE PRIME ... I'VE ALSO INCLUDED A TON OF INFO YOU CAN USE THROUGHOUT YOUR JOURNEY. GOOD LUCK! GOD BLESS YOU ... DAWN & NICk PS: IF YOU NEED A LIST OF CO-MORBS, LET ME KNOW ... I HAVE ONE THAT MAY HELP YOU.

Yeah!!! I do have Tricare Prime!!!!!!!!! I think my BMI should be like 41.(as long as it is at least 40 I am ok, right? I would just hate to be denied because I am a couple of pounds off.) Thanks so much it helps me know what to make sure I ask for.(my PCP will prob. know what I need right? I am not using a doctor on base since Fort Jackson has so many privates my PCP is actually a civilian doctor; although he does have quite a few military spouses that he treats. Do I need to ask for these things imparticular like Evalation and treatment referal,etc. ; or should he just know what to send in atomatically? Alos what are Co-morbs? I feel so dumb asking but I really have no idea? Thanks so much again, Jaye Jaye

A BMI OF 40 IS A "SAFE" BMI TO BE APPROVED FOR GASTRIC BYPASS ... ANYTHING HIGHER JUST MAKES YOUR CASE THAT MUCH "BETTER" FOR APPROVAL. YOU CAN BE APPROVED WITH A BMI OF 35 TO 39 BUT YOU WOULD HAVE TO HAVE VERY, VERY SERIOUS CO-MORBS. SO, I'LL NEVER TELL YOU THIS AFTER SURGERY, BUT FOR RIGHT NOW DON'T DIET OR TRY TO LOSE WEIGHT. THE WEIGHT THEY USE FOR YOUR APPROVAL IS THE WEIGHT YOU ARE ON YOUR FIRST APPOINTMENT TO YOUR GASTRIC BYPASS SURGEON'S OFFICE. YOUR PCP/PCM WILL PROBABLY KNOW BUT IT NEVER HURTS TO REMIND HIM/HER. IF YOU GET AN "EVAL ONLY" REFERRAL, YOU WILL BE AUTOMATICALLY DENIED GASTRIC BYPASS SURGERY BECAUSE YOUR REFERRAL DID NOT GIVE YOUR GASTRIC BYPASS SURGEON PERMISSION TO TREAT YOU. THAT IS WHY YOU NEED AN "EVAL & TREAT" REFERRAL. THIS CAN BE FIXED LATER, BUT BEING DENIED WOULD BE SOOOOO STRESSFUL, ESPECIALLY JUST FOR AN ERROR OF NOT HAVING THE CORRET TYPE OF REFERRAL. &, BE SURE TO ASK YOUR PCP/PCM FOR A "LETTER OF MEDICAL NECESSITY". IT WAS MANDATORY TO HAVE AT LEAST ONE FROM ONE DOCTOR WHEN I WAS APPROVED ... NOT SURE IF IT IS NOW, BUT THIS LETTER MEANS THAT YOUR HEALTH IS SUFFERING FROM YOUR WEIGHT/OBESITY ISSUES & IT IS A POWERFUL DOCUMENT IN YOUR FAVOR. IF YOU HAVE OTHER SPECIALISTS, YOU CAN ASK FOR LETTERS OF MEDICAL NECESSITY FROM THEM AS WELL, BUT ONE IS ALL I NEEDED. MY PCP/PCM IS CIVILIAN AS WELL ... DOESN'T MAKE A BIT OF DIFFERENCE, BUT REMINDING THEM NICELY WHAT YOU NEED IS WISE AS THEY DEAL WITH SO MANY DIFFERENT INSURANCE REQUIREMENTS. SO, YES ... BE SURE TO TELL HIM/HER EXACTLY WHAT YOU NEED ... "EVAL & TREAT" REFERRAL TO A GASTRIC BYPASS SURGEON. IF YOU KNOW OF A REALLY GOOD ONE, YOU CAN EVEN MENTION HIS/HER NAME & IF THEY ARE ON TRI CARE'S LIST, THEY WILL USUALLY TRY TO SEND YOU TO THE ONE YOU ASKED FOR. JUST ASK HERE ON THE BOARD FOR RECOMMENDATIONS FROM OUR LADIES & GENTS FOR SURGEONS IN YOUR AREA. CO-MORBS ARE THE MEDICAL CONDITIONS THAT CAN BE ATTRIBUTED TO YOUR WEIGHT/OBESITY CONDITION. FOR INSTANCE, HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, SLEEP APNEA, DIABETES, WEIGHT-BEARING ARTHRITIS ARE ALL CO-MORBS OF OBESITY ... OBESITY CAUSES/WORSENS THESE CONDITIONS & MANY OF THESE TYPES OF CONDITIONS WILL COMPLETELY CLEAR UP, OR DRASTICALLY IMPROVE AFTER SURGERY & WEIGHT LOSS. YOU CAN'T JUST BE HEAVY TO GET THIS SURGERY ... YOU HAVE TO PROVE THAT YOUR HEALTH IS BEING DAMAGED BY YOUR WEIGHT/OBESITY ISSUES, SO YOU NEED TO LIST MEDICAL & LIFESTYLE ISSUES AFFECTED BY YOUR OBESITY - THOSE ARE YOUR CO-MORBS. I'LL POST THIS LIST ... GOD BLESS YOU ... DAWN & NICk

NOT ENOUGH CO-MORBs?????? Original Post by Lady D * at 10:05 AM PST on 09/15/2005 Summerville, SC - RNY (10/28/2005) I'M A BIT HEAVIER THAN MOST ON THIS BOARD, BUT YOU NEED TO REALLY GET CREATIVE WITH THE CO-MORBS IF YOU ARE A TRUE "LIGHTWEIGHT". MY DR HAD TONS OF WEIGHT-RELATED ISSUES ... HERE'S WHAT I CAN REMEMBER ... NORMALLY YOU NEED A BMI OF 40 & BE 100 #s OVERWEIGHT, BUTTTTT ... DO YOU HAVE - DIEBETES - HIGH BLOOD PRESSURE - HIGH CHOLESTEROL - ACID REFLUX, HIATAL HERNIA, REGURD DISEASE, SEVERE HEARTBURN - FLUID RETENTION OR SWOLLEN JOINTS - ARTHRITIS, DEGENERAGIVE BONE DISEASE (ESPECIALLY IN THE LOWER BACK) - LARGE BREASTS = RUTS IN YOUR SHOULDERS (NERVE DAMAGE FROM THESE PRESSURE POINTS FROM THE BRA STRAPS) ... SHOULDER, NECK OR UPPER BACK PAIN ... HEADACHES OR SEVERE TENSION AT YOU NECK/SKULL - RASHES UNDER YOUR BREASTS OR STOMACH OR BETWEEN YOUR THIGHS, ETC. - CARPAL TUNNEL SYNDROME (SECONDARY CO-MORB) - HEAVY MENSTRUAL FLOW (SECONDARY CO-MORB) POOR BLADDER CONTROL ... DO YOU "SQUIRT" WHEN YOU LAUGH, COUGH, GET UP OUT OF A CHAIR, ETC - SLEEP APNEA ... SNORING, COUGHING, CHOKING, APNEA (STOPPING YOUR BREATHING) - SEVERE PAIN/DAMAGE IN ANKLES, KNEES & HIPS - EXHAUSTION ... TAKE NAPS DURING THE DAY OR NEED TO RECOUPERATE AFTER ANY PHYSICAL EFFORT ... NEED TO REST DURING LONG PERIODS WALKING LIKE WHEN SHOPPING LIFESTYLE LIMITATIONS ... - LITERAL HUFFING & PUFFING PERFORMING "NORMAL" DAILY ACTIVITIES - LIMITED OR UNABLE TO PERFORM NORMAL FAMILY ACTIVITIES - " " " " PERFORM SEXUALLY - " " " " PERFORM EMPLOYMENT DUTIES - NEEDING HELP BATHING, TYING YOUR SHOES, DRESSING, TAKING CARE OF YOURSELF ... WHAT HAVE I MISSED LADIES GOD BLESS DAWN & NICK RE: NOT ENOUGH CO-MORBs?????? Response from Karen P at 6:45 PM PST on 09/15/2005 Erie, PA - Amjad Ali, M.D. Hi Dawn, That was a great list. The only other one I can think of is hyperlipidemia (I think that's it) high lipids. You always have great posts. Karen RE: NOT ENOUGH CO-MORBs?????? Response from Andrea B at 12:57 PM PST on 09/17/2005 Slayton, MN - RNY (05/04/2005) Here are a few more that I have thought of: Depression Pain in feet (Arthritis) gall bladder issues Asthma going 2 months or more between periods Fatty/Large/Diseased Liver & ... COPD & DEGENERATIVE BONE DISEASE, ESPECIALLY IN THE LOWER SPINE ARE ALSO CO-MORBs ... DON'T REMEMBER IF I PUT THIS ON THE LIST, BUT IF YOU HAVE A WEAK BLADDER IN WHICH YOU URINATE WHEN YOU LAUGH, SNEEZE OR STRAIN YOUR STOMACH MUSCLES ... THAT'S A CO-MORB. ~~~~~~~~~~~~ LIGHTWEIGHTS" (BMI ABOVE 35 & NO MORE THAN 120#s OVERWEIGHT) ... USUALLY AVERAGE BETWEEN 80 & 100 #s OVERWEIGHT. THE BASE CRITERIA FOR WLS IS A BMI OF 40 OR MORE & AT LEAST 100 #s OVERWEIGHT. BECAUSE THEY HAVE A HARD TIME QUALIFYING SINCE THEIR NUMBERS ARE SO LOW, I PUT TOGETHER A LIST OF WHATEVER I COULD FIND ON CO-MORBS. IF YOU HAVE ANYOF THE ABOVE, YOU PRIMARY CARE MANAGER (PRIMARY/FAMILY DR) SHOULD WRITE A LETTER OF NECESSITY BASED ON THE FACT THAT YOUR CO-MORBs HAVE BEEN GETTING WORSE & THAT BY HAVING WLS, YOUR CO-MORBS SHOULD IMPROVE OR BE COMPLETELY HEALED. ALSO, LIFESTYLE LIMITATIONS CAN BE USED ... SUCH AS ... ... CONSTANT PAIN IN NECK SHOULDERS & UPPER BACK BECAUSE OF BRA PRESSURE & WEIGHT OF BREASTS ... WALKING LIMITED BECAUSE OF JOINT PAIN ... LOWER BACK PAIN CAUSING MOVEMENT & WALKING LIMITATIONS ... SEXUAL LIMITS BECAUSE OF OBESITY ... NOT BEING ABLE TO TIE YOUR SHOES (CAN'T BEND OVER FAR ENOUGH), OR DRESS YOURSEF COMPLETELY WITHOUT HELP ... or CAN'T CARE FOR YOUR FEET, TOES & TOENAILS ... NOT BEING ABLE TO CLEANSE YOURSELF PROPERLY AFTER USING THE RESTROOM (MANY OBESE HAVE THIS PROBLEM) ... NOT BEING ABLE TO CARE FOR YOUR CHILDREN PROPERLY (CAN'T CARRY OR PICK UP A SMALL CHILD, FOR INSTANCE.

Good luck Jaye Jaye. I went for my first consult on March 8 and had my surgery on April 9th. Tricare is easy and fast to get approved.

Thanks so much for the word of hope Tanya. Did you have to get your surgery on a military base, or did they let you choose? Did you have the regular Gastoric Bypass or did you have the laproscopic Gastoric Bypass?