More questions?????

From the time of intial consult to surgery how long did it take to do all the pre op and approval before the big day? Has anyone *****ceived referral for WLS been denied by Tricare, or since I have the referral, this means that I won't be denied. Thank you friends for all your help....I don't know what I would do without you all.

I was initally denied, but I found out that when I first sent in my packet for approval, tricare had changed their requirements and I missed the weight requirement by 6 pounds. I have now met the weight requirements and have sent in my appeal packet. Tricare received the packet on August 4th and all they can tell me is that they have recieved it and someone is working on it. From what I hear, if you meet the 100 pounds overweight and the co-morbities you should have no problems. Just make sure that you have all of the requirements met before you send in your paperwork so it will save you some stress and heartache. Layla

off topic ~ Layla, I was just peeking at your profile earlier today to see if you had an update yet. I can't believe Tricare is taking this long! Grrrrrr. I'll keep my fingers crossed for you!! Andi

I know... It is literally driving me insane!!! Just tell me approved or denied so I can go on with the next step. This not knowing is for the birds. Layla

I had my first consultation with my surgeon's program manager on May 2d. A month later after I meet all my surgeon's pre-op requirements on June 6th my paperwork was submitted to Tricare and I was approved on June 8th. A month later on July 6th I had my surgery. Layla is correct, Tricare only requires two things (that I could ever find) and that is that you meet the weight requirement (over 100lbs of your ideal body weight with a co-morbidity or 200% of your ideal body weight without a co-morbidity) and the pysch eval. Got these two things met and you are good to go! GL! Andi

Now, I am worried as I know I am 100 pounds overweight but I do not think I have the comorbidties. My referral says medically necessary. Does that change anything. I wonder if because my thyroid is borderline, and I cant tolerate the medication if this will qualify me. I know that I am being for depression, does this qualify as one? For me to bee 200% of my body I need another 30lbs on me....o gosh this is truly upsetting, I mean my PCM and I discussed the qualifications for Tricare and I don't think he would have done it if I didn't qualify. Frustration at every turn....hmmmm

Wendi, Tricare uses the Metropolitan Life Table, so you may be more overweight (according to Tricare) than you think. Here is a link for a copy of the table. http://www.halls.md/ideal-weight/met.htm Tricare uses the lowest weight on the medium frame (unless your surgeon says you are small framed). They'll just mulitply that number by 2 (with no-comorbidities). I made the weight cutoff by only 6 lbs. I was concerned too. HTH Andi

By that scale, I am still 10lbs shy of 200% hmmm. I will not give up, I will not give up, I will not give up......

Do what ever you have to do to meet the requirement. Comorbidities are: diabetis, high blood pressure, high cholesterol or trigylcerides, sleep apnea, arthritis, asthma, or anything that is caused or exaserbated by your weight. The older you get the more you will develope. But, believe me you don't want to wait. My arthritis is extremely painful and I can't get all of it fixed. No one is touching my back with any surgery. I don't think depression counts and thyroid does not. Medically necessary to Tricare means you meet the requirements. Don't give up, but you might get depressed and eat lots of donuts and ice cream for a week or two. (oops, I didn't tell you that) It took about 8 weeks from the time my orthopedic surgeon sugested it to surgery. I had to see my PCP and then start with the surgeon. Hang in there, Diana

Have you had a doctor determine if you are small boned? If you are you'd qualify. I wouldn't give up either! It is getting colder outside. If someone went to a weigh in with heavy boots on, heavy sweater or sweatshirt, it wouldn't be so odd..... Andi