Insurance Update

Hi Everyone, OK, rocky road this morning. Called ins first thing about denial and was told to begin writing letter for appeal process because I don't weigh enough. She said she couldn't tell me how much I needed to weigh but that I don't weigh enough. I'm 5' and 235lbs. 44.9BMI. Called Kim at Dr. Bour's and she called back to tell me everything would be ok. That she spoke to medical review and they need blood for for thyroid and stomach bacteria and that the cs on the phone didn't know what she was talking about. Whew!!!! Go tomorrow for blood work. Wish me luck. Thanks for the support everyone, Melony

Melony, I am sure that Kim will take care of everything for you!! Keep your chin up and soon you will be telling us you have approval and a date Lots of luck coming your way Melissa

Thank you, Melissa. When did this process start for you? Mine started at the end of January, so I don't mean to complain. Talk to ya later, Melony

Good Luck girl!!! I hope that you get that letter of approval soon. Keep us posted!! Britt

Thanks Britt! Oh my gosh, I just read your profile and you must be so excited. I can't imagine losing over 100 lbs. Amazing!

You keep the faith Melony! You qualify with an "over 40" BMI, and Kim will fix it with Tricare ... I know she will! This whole mess-up was probably caused by someone at Tricare not doing their job right. Good luck tomorrow with the blood work ... and stay patient! ~ Dawn

At 5', you definitely weigh enough for WLS criteria ... So, that is bogus as your BMI is sufficient as well ... So glad you found out about the necessary bloodwork, Ms Melony!

I'm glad Kim is working it out for you...I don't know what's going on at Tricare CS...my husband had a bad experience with one of them today. He had to call back...got someone else and the problem got fixed, thank God. Maybe they need to do some more training on customer service or something. Tonya

Good Morning! I went for bloodwork yesterday and was told that I should know something in 24-48 hours, then surgery date! I'm holding my breath. But Kim at Dr. Bour's office was just as nice as she could be. She said she had no idea why I was told that and that it had nothing to do with my weight. The CSR from TriCare told me to gather any info available and go to all Dr's and get letters from family members and pics, etc. I would need all the help I could get. Why didn't she just say it was denied pending additional info? Or better yet, why wasn't it just still pending? I don't know, but I had complete hysterectomy in December and the evening before surgery, they informed me that I wasn't approved, even though 6 weeks earlier, they said I was. I threw a huge fit and decided to go ahead with the surgery and let them work it out. I think it's because we're retired USAF. My husband has been retired 3 years and was in 24 years. We're 2nd class citizens now. We never had any problems when we were active. Through fussing!!! Let's just say my roller coaster is loading passengers and I'm not riding up or down any hills until I have a BIG A instead of D. Thanks everyone. Melony

IF THEY GIVE YOU ANY FURTHER PROBLEMS, MS MELONY ... ASK FOR THEIR DENIAL & EXPLANATION OF THEIR DENIAL IN WRITING ... THAT WAY YOU & YOUR SURGEON'S OFFICE WILL KNOW EXACTLY WHAT THE PROBLEM IS. IF YOU CANNOT GET IT RESOLVED, ASK FOR THE NEXT PERSON UP THE FOOD CHAIN & BE SURE TO KEEP EVERYTHING IN WRITING & KEEP THE NAMES OF WHO YOU TALK TO & WHAT WAS SAID. AS FOR NEEDING LETTERS OF MEDICAL NECESSITY & OTHER PERSONAL INFORMATION, THIS IS NOT OUT OF THE ORDINARY. I USUALLY SUGGEST THAT EVERY PATIENT WRITE 2 VERY, VERY DETAILED DOCUMENTS RIGHT IN THE BEGINNING ... THE FIRST DOCUMENT NOTES EVERY SINGLE MEDICAL ISSUE YOU HAVE FROM PAIN IN YOUR SHOULDERS FROM YOU BRA STRAPS TO DIABETES & MORE SERIOUS CO-MORBS. ALSO, WRITE WHAT YOU HAVE TO DO FOR RELIEF OR, THE FACT THAT YOU CANNOT GET RELIEF FROM THE MEDICAL CONDITIONS ... HOW ABOUT RASHES ... HIGH BLOOD PRESSURE ... SLEEP APENA ... &, ON & ON ... I'LL POST A LIST OF CO-MORBS ... YOU MAY BE SURPRISED WHAT YOU CAN CLAIM. CLAIM IT ALLLLLLLLLLLLLLLLL! THE 2nd DOCUMENT SHOULD BE NOTING YOUR LIFESTYLE PROBLEMS ... HAVE TROUBLE OR CANNOT PERFORM SEXUALLY, SAY SO & WHY & HOW THAT MAKES YOUR FEEL OR WHAT KIND OF STRESS IT CAUSES IN YOUR MARRIAGE. DON'T HAVE THE ENERGY TO PLAY WITH YOUR KIDS ... CAN'T DO HOUSEWORK OR HAVE A HARD TIME DOING IT ... NEED HELP GETTING IN & OUT OF THE TUB, BED, CAR OR ON OR OFF THE COUCH ... HUFF & PUFF WHEN WALKING ... CAN'T FIT IN NORMAL CHAIRS IN PUBLIC ... SAY SO ... BE BLUNT ... BE BRUTALLY HONEST AS TO THE LIMITATION OBESITY CAUSES IN YOUR LIFE. ALSO, NOTE SOME OF YOUR EFFORTS & FAILURES AT DIETING ... THE POINT IS THAT YOU CAN LOSE THE WEIGHT BUT NOT KEEP IT OFF SO THE POUCH WILL BE A GREAT TOOL TO OVERCOME THE GENETICS & MOTABOLISM ISSUES. BE BLUNT, BRUTALLY HONEST & PRO-ACTIVE. DO NOT SOUND PISSY OR ANGRY ... YOU ARE DEALING WITH HUMAN BEING WHO WILL BE EFFECTED MORE BY YOUR DOCUMENTS & YOUR ATTITUDE THAN BY THE MEDICAL INFORMATION YOUR DOCTORS SUPPLY. NO, YOU'RE NOT BEING TREATED AS 2nd CLASS CITIZENS, MS MELONY ... NICK IS RETIRED NAVY & I WAS APPROVED WITHOUT A PROBLEM, BUT I DID WRITE THE DOCUMENTS I MENTIONED & THEY WERE SUBMITTED WITH MY FIRST PACKET GOING TO TRI CARE PRIME. SOMEONE SHOULD HAVE TOLD YOU TO COVER YOUR BASES BEFORE SENDING IN YOUR PACKET ... EVERYONE NEEDS MEDICAL LETTERS OF NECESSITY & EVERYONE SHOULD WRITE UP THERE OWN DOCUMENTS TO VALIDATE WHAT THE DOCTORS' REPORTS STATE. THIS IS YOUR SURGERY; SO BE PRO-ACTIVE & FIGHT ... DON'T WASTE YOUR TIME BEING ANGRY! THIS IS ANYWHERE FROM $35.000.00 - $50,000.00 WORTH OF SURGERY SO SOMEONE SHOULD BE WATCHING OUT TO MAKE SURE A PATIENT REALLY NEEDS WLS ... ALSO, THIS IS A MAJOR, MAJOR SHOCK TO THE WHOLE BODY BECAUSE OF THE MASSIVE CHANGES IN OUR DIGESTIVE TRACKS & YOU WON'T BELIEVE HOW MANY CHANGES IN YOUR LIFESTYLE YOU WILL HAVE TO MAKE & THE EMOTIONAL ISSUES YOU WILL FACE, SO THEY WANT YOU TO BE A SUCCESS CASE ... SO, JUST GET FOCUSED & PROVE TO THEM THAT YOU ARE AWARE OF THE CHANGES, THE RISKS & THE POTENTIAL ... AS WELL AS WHY YOU WILL BENEFIT DUE TO ALL THE HEALTH & LIFSTYLE ISSUES THAT WILL BE RESOLVED FROM THIS SURGERY. DON'T WORRY ABOUT BEING EMBARRASSED WITH A SUBJECT. IF YOU'RE EMBARRASSED TO WRITE SOMETHING, THE PERSON REVIEWING YOUR PACKET WILL FEEL EMBARRASSMENT FOR YOU & THAT HELPS YOU. WE'RE ALL HUMAN. GOD BLESS YOU DAWN & NICK