Got a referral... what will stop me now?

Based on reading other people's posts, it looks like I have a good chance to be approved by Tricare. My BMI is well over 40. Mine is 58 and I have at least 2 co morbidities. I have high BP and sleep apnea. Not to mention an old ankle injury that is aggravated by my weight. Heck, the way the doctors sound, my 4th of July sunburn is a comorbidity too! LOL My concern is that I haven't documented my weight loss attempts. I have tried several times over the last 17 years (since I was 12) but nothing official or under a doctor's care, including weigh****chers, and with very little success. I have already been referred to have the surgery by a physician, and also for sleep study for sleep apnea, and I requested a referral to a nutritionist because I understand that is part of the process. What I am wondering is if the surgeon is going to require me to have documented weight loss history, what they are trying to establish during a psych evaluation, and is a history of depression going to prevent me from getting the surgery?

Hi Amethyst.. for me I got my referral to see the surgeon. I filled their paperwork out which basically was your heath history. As for the weight loss attempts it was just that. I put down all the attempts.. ballparked the dates and how much you loose and regain. That was it. I got my referrals from my PCP for all the preop appointments that are required from my surgeon.. Psych, nut.. which btw was not covered by Tricare... WTF.. I went to a MTF...Pulmonary guy.. heart guy... xrays and ultrasounds... after everything was done the surgeon submitted.. I got approved in 48 hrs... and got a date... From what I hear about the depression... As long as you have it under control then there shouldn't be a problem. During my psy eval it was mostly just talking about making my decision. Most of it was on paper.. do you want to hurt yourself.. yada yada... But.. answer it honestly because there is a reason they have these questions. Erin

I am concerned that some of your appointments were not covered by Tricare. Are you Tricare Prime? It is such a zoo getting all the appointments set up. Looks like I will be traveling all over the state and back for different things, so it is going to be an adventure. Also, The communication between MTFs is severely handicapped.

My surgeon just wanted me to list the attempts I've made. I did have one dr supervised (phen-fen). My records are not even availiable for that becasue that Dr left the country with all his records when all the lawsuits came out. I had tried weigh****chers and Atkins. That's all he needed. Just my word. My surgeon also has a nutritionist on staff. I would wait on the nut because surgeons have ones that they are used to working with. With a 58 BMI you shouldn't need any comorbidities. If you don't have them now, you will have. Tricare would rather avoid them by getting the weight off you. My BMI is only 42, but I do have comorbidities and I had no problems being approved. Diana

I am on the same page as you. I got my referral from Tricare to see the doctor and I am going to my educational class on August 16th. I am a little worried if Tricare will approve me. I have a BMI of 43. I have lower back pain and bad joint pain. I don't know if those are co-morbidities, but I know they are effected by my weight. Keep us posted on how things go. I am riding this roller coaster with you. Good luck.

My understanding is that if you're BMI is under 40, then you have to have comorbidities, but if you are over 40 (like I am for real!) then you don't need comorbidities. My surgery was approved the day my doctor submitted it... it looks like it will be done at a military hospital, which is where I had my c-section... hey, I wonder if they can use the same incision since they did a vertical incision (belly button down) rather than the smiley face... I still have quite a scare, it would be nice to recycle that one. lol I don't know if lower back pain and joint pain are considered comorbidities though. I interpreted that to mean secondary conditions, caused by obesity that can lead to death by themselves.... like diabetes, heart disease/high blood pressure, sleep apnea, etc. I have lower back pain sometimes too, and joint pain always!

Im seeing an Army doctor for my surgery so approval was not a problem, but I know my BMI is over 40 and I have Asthma, osteoarthritis and back pain. They approved me. I only had to show my weight loss attempts with them. General Surgery set up my EKG, my chest xray and my Endoscopy, I had to set up the psych eval and nut but I got my appointments at the same hospital that is doing my surgery. I haven't had to pay anything out of pocket "yet" lol no telling when they might send me a bill you know the Army lol. I wish you luck Donna Ft. Stewart Ga

I went to my pcm for a follow-up from a stay in the hospital for a bit of everything but he put the referral in and i wited for the call saying i was put out in town and my appointment was on july 24, july 31 i got a saying i was approved for surgery and we set a date...tricare doesnt cover the nutritionist class of 93.00 or the 10 day protein diet of 50.00 or the post op kit of 75.00 but everything else is 100%. hope this helps put some....my date is sept 5th...good luck