Hi All-Newbie Here

Hey Everyone-

I'm new to the forum and the whole WLS process. At this point I've jumped thru all the Tricare hoops and am waiting to see if I'll be approved for surgery or not. It's been about a week since I had my first consultation and I haven't heard anything back from them yet. I will definately call on Monday to see what's going on. This waiting game is killing me!

Anyhow, I wanted to chime in to say hello & possibly make some new friends who are in the same boat as I.

Vanessa

Welcome to the board... it is quiet around here right now.  I guess everyone has been a little busy around here lately.  I know how hard it is with the waiting game.  Seems like tricare takes their sweet *** time getting you an answer.  I am saying a prayer for you and your approval. Just keep thinking positive and it will happen soon.  If you need anything feel free to send me a message.  Layla

Hey Layla-

Thanks a million! Unfortunately it doesn't look like my journey will be an easy one. I looked online today at the Tricare website and saw a big ole "not approved" under my status. When I went to check the mail, there it was a denial letter. I plan on appealling their decision because I feel I more than qualify at 128 pounds over my ideal, a BMI of 43.5 and I suffer from reflux so we'll see.

Vanessa

Did they give you a reason for the denial?  I was initally denied also, but my issue was not being enough overweight.  I did gain it by the time I sent in my appeal letters.  I just had the surgeons nurse write and letter, some of my family members also wrote letters and I wrote one.   It all worked out in the end and it will with you, too.    If you have any questions or need any input on the appeals process  just let me know, and I will do my best to help.  Keep thinking postitive thoughts...Layla

According to the letter it said either one of two things weren't met. The first one was about being the 100 pounds over & having medical issues and the second said being 200% over the IBW. I was going for the first one, 100 lbs over & medical conditions which mines would be that I suffer from reflux but that wasn't good enough so now I think I'm going for an appeal. I've never done this befor so any and all input would be appreciated. My doc has been supportive from teh start so I think I may pay her a visit and see if she can write a letter along with the pysch doc who was also all for me getting it. I know for a fact I can get some family to write letters as well so we'll see.

My two comorbities were(i had more than two) ibs, joint problems(arthritis), blood pressure issues, and depression.  See if you can find (with your doctor) any other comorbities and that will help you out more than any thing.  If you don't have those two and weigh the 100 pounds over they won't approve.  Or you can be the 200% overweight.  Try to find the problems first and remember you have 90 days(i think) so take your time get all of your ducks in a row and do it right so you don't have to start all over.  Like I said if you ever need anything Just ask.... Layla

I was thinking that perhaps I had "rushed" thru some things myself. I know for a fact I have reflux & if I don't take my meds in the morn I'm out a day. I also have polycystic ovarian disease which I was told that being this over weight wasn't helping my situation any but of course, my problem is keeping the weight off. As for what else, I'm fatigued all the d*** time, I find it hard keeping up with my kids, my sex drive & life are non-exsistant, I do suffer from depression issues as well. Sometimes I have good days and sometimes I have bad ones and I have been checked for bi-polar disorder because even I was thinking maybe I had it with my emotions being so up and down from day to day but they ruled that out. I do plan on seeing my PCM this week to see if together we can compile a list and if she'll be kind enough to take some time from her already busy schedule to write a letter of recommendation.

I appreciate you taking the time out to talk with me about this. I feel like I'm fighting this battle alone and it's nice to know there are other people out there with similar situations that can offer their advice.

Vanessa

Anytime.....  just send a personal message.  Hugs, Layla

Hi Vanessa & Layla, Im luckily not going throught tricare but the hospital here on base ( wright-Patt AfB) does alot of these procedures...Vanessa you should have definitely been approved as long as your 100lbs OW that shouldnt have been a problem and you wouldnt need a comorbity. If your BMI was over 40 which it looks like it was you should have been approved hands down. THATS SOME BS! Well I hope everything works out for you soon. Layla youre looking great!!!

Sincerely,
Re

Hi-

The day of my consult (9/12) the assistant asked if they had checked my cholesteral which I figured they had because they took a million vials of blood the day I had my labs done. For whatever reason, the 1st page of my results was missing.

So I called the clinic on base as soon as I left my consult appointment to make sure and surely the person who had faxed over the results had left out that first page. So I had her fax it over and I'm thinking now that when the WLSC faxed my paperwork to Tricare, page 1 of my labs was still missing. I probably should have called them to notify them of the error and what I had done to correct it but I guess I kinda figured that since it was friday, my packet to Tricare wouldn't go out until the following monday. I now believe I was wrong in assuming this because Tricare denied my surgery as of the 17th.

So this morning I went to the clinic on base to get a copy of page one for my own records. After reading it, I now know I also have high cholesteral soo I'm wondering if this page had been sent in what would my outcome be?

I re-read the Tricare letter and it says if I have any questions to call the number provided which is also the same number on the back of the Tricare card. I called and the lady said the ONLY thing she could tell me was to call the WLSC because they too would have a letter and if I felt I was denied wrongfully, I'm within my rights to appeal. Well DUH!!!

I do plan on appealling but it would help me out that much more if I knew the reasons I had been denied as the Tricare letter is very very general. It just states I didn't meet their requirements but I am 100+ over, my BMI is 40+ and my 2 co-morbs would be GERD and high cholersteral. I called the WLSC because technically I need to give up my surgery date of 10/24 which I plan on doing and I wanted to know if they had received this letter as well. Well of course, my appointed person isn't in just yet so I left her a voicemail.

I have been blessed by Vicki because she is helping me with my appeal paperwork but until I KNOW for sure why I was denied, I can't really go on to the next step. I've been told too many times that it could be a missing paper and I am thinking this is EXACTLY what happened to me.

As for surgery, I still am seeking to get it but have decided to wait until after the holidays. With Halloween, Thanksgiving and Christmas sooo close, we can not afford to shell out the $250 for surgery and still be able to afford the holidays. I'm thinking if I can get a date for January it will be all around better, I have plenty of time to file my appeal properly, I can enjoy one last set of holidays (spending wise) and I don't know, it just seems like it would be best all around.

Anyhow, I just needed to kinda update a little and maybe get some of my thoughts out to kinda clear my mind.

Vanessa