Recent Posts

absynthefairyfirefly
on 4/5/08 6:20 pm
Topic: more questions
Hi. I have a bmi of around 39. I plan on calling my pcp on Monday to see if he can help me set of gastric bypass, but he's one of those do it yourselfers. I really don't have any chronic medical conditions unless you count lots of body aches and occasional b/p problems. I've been seeing him for about a yr or so. I've been on the diet pills and all that good jazz. I'm from Tn. Does anyone out there have any pointers? I really don't know much about what to do if you're denied or your Dr. really doesn't approve of alternative weight loss management. Just trying to prepare myself for the could be battle. Thanks.
CaptainAmericasWife
on 3/29/08 11:42 am - Monterey, Korea (South)
Topic: RE: Wiliford Hall, San Antonio
Wilford Hall also does fully body lifts! I haven't done it, but I know ppl who have. The surgeons need to keep up their skills so they're more than happy to take on various types of surgery. Just thought I would let you all know. Bex
Megan M.
on 3/29/08 9:15 am - Cordova, SC
Topic: RE: Tricare Prime bypass approval
I have to agree with the above poster, but this may put your mind at ease. Just keep in mind that just b/c it happened for me doesn't guarantee that it will happen for you. I had a BMI of 41, which Tricare doesn't give a crap about they don't look at your BMI and I also have Reflux, which Tricare does give a crap about. I was denied on March 3rd b/c the results from my Upper GI weren't sent to Tricare w/ all my other info. Whenever my Dr.'s office filled my appeal they included the results from my Upper GI and I was approved within 10 days. Best of Luck to you!!!
Wendi W.
on 3/28/08 4:29 am - Waukegan, IL
Topic: RE: Tricare Prime bypass approval
Lee, First off, Hello and welcome. Here are what I hope are answers to some of your questions. First off, Tricare does not require a 6 month diet. So, the only diet you may have to do is pre op to shrink the liver and that is determined by your surgeon. Here is how it works. 1. PCM sends referral to Tricare for authorization. Tricare will approve or deny the request. If they approve, they will send you to an in Network provider. 2. Tricare's requirements Gastric Bypass (Surgery for morbid obesity) - Limited Benefit - Gastric bypass, gastric stapling, gastroplasty, and vertical banded gastroplasty may be covered when one of the following conditions are met (view Hospitalization Costs): The patient is 100 pounds over the ideal weight for height and bone structure and has an associated medical condition, such as diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints. The patient is 200 percent or more of the ideal weight for height and bone structure, regardless of associated medical conditions. (this is by using the metropolitian weight table.) Laparoscopic adjustable gastric banding is covered, effective February 1, 2007. The following are not covered: Biliopancreatic bypass (jejunoileal bypass, Scopinaro procedure) (CPT codes 43645, 43845, 43847 or 43633). Gastric bubble or balloon Gastric wrapping/open gastric banding (CPT code 43843) Unlisted CPT codes 43659 (laparoscopy procedure, stomach); 43999 (open procedure, stomach); and 49329 (laparoscopy procedure, abdomen, peritoneum and omentum). 3. Once you have your consult, there will be some tests that will need to be done. Prior to consult, you can have your PCM do these referrals and get ahead of the game. Psyc Eval Pulmonologist - they may need to do a sleep study You will need a full work up of labs from A to Z (when I get this done is about 7 tubes of blood) - Also make sure that you get a Hypolori test (this rules out peptic ulcers) Nutritionist consult. - if you are near a military medical facility, they sometimes have them available, just need referral from PCM. The bad news is that I do not think Tricare will pay for this. Your PCM will need to write a letter of medical necessity, and you will also need an EKG done and signed off on by the doctor. The above items is what exactly is requested by Tricare but, the surgeon my have other tests that need to be done. Oh and one last note, I would get a full exam to document all aches pains and illnesses you may have to help in your quest. Good luck.
vamomma69
on 3/27/08 10:01 am - Fredericksburg, VA
Topic: Tricare Prime bypass approval
I just saw my civilian PCM and said I want to see if I qualify for the surgery and she wrote down my height, weight, BMI, cholesterol and possible acid reflux and arthritis, but that's it. Is tricare going to laugh at this and send back a big fat NO for surgery referral? And do you get the initial referral to a surgeon and THEN get a final approval after the surgeon does the work up on you with the psychiatric and all the other evaluations they do prior? My problem is I am only 90lbs overweight, with a BMI of 42.8 and cholesterol in the mid 200's . . . those are the only things that are documented in my medical records. . . . I don't want to have to diet for 6 months with a Dr's supervision when I have already tried to lose the weight over the last 10-13 years just to gain it all back again . . . . . any information will help!
prettydove
on 3/18/08 10:19 am
Topic: USPS Flat Rate Military Discount
The U.S. Postal Service is rolling out a new, larger flat-rate box that will feature for the first time in Postal Service history, a military discount for those mailing to APO and FPO addresses. Regardless of how much they weigh, the boxes will cost $12.95 to mail for the general public, and $10.95 if mailed to an APO or FPO address, postal officials said. The boxes themselves are free. The larger new box will provide about 50% more space to stuff items than the old version, officials said, with a volume of about half a cubic foot, compared to about one-third cubic foot for the two existing flat-rate boxes. The new box measures 12 inches by 12 inches by 5½ inches. The two current flat-rate boxes cost $8.95 to mail to domestic and APO or FPO addresses, and will still be available. They come in two different shapes. Customers can begin using the new flat-rate box at the new mailing rates March 3. The boxes will be available online by Feb. 20 at http://www.usps.com/supplies or by calling (800) 610-8734, but will be weighed and charged at the usual postal rates if they are mailed before March 3. Postal officials will provide a special version of the box for the military, featuring the logo of "America Supports You," a Defense Department-sponsored program designed to bring together more than 300 charitable and support groups and connect them with service members and their families. The new package also will feature an address box for APO and FPO addresses. The military boxes will be distributed on a more limited basis, primarily in areas closer to installations. But the discount depends on the address, not the box. All of the larger flat-rate boxes will receive the $2 military discount if they are mailed to an APO or FPO address. The Postal Service's Board of Governors approved the box Jan. 17, and stated in their decision that the discounted mailing fee "provides an opportunity for the Postal Service to assist American troops stationed abroad and their families."
lonebaldy
on 3/14/08 5:05 pm
Topic: 1st Cav Vietnam 3 Spearhead Gunner 1967 1968
Seeking info, last name: Lindsey, Southern California email: [email protected]
Robin O.
on 3/13/08 3:32 pm - Sheppard AFB - Wichita Falls, TX
Topic: RE: Hello to all....
Hello! My husband is AD AF for 11 years, we been married for almost 3 years. Since the marriage we have been here in AZ once he got back from Korea. I am hoping to have surgery. Came close once, had a date then a big mess with hospital and surgeon. Not sure what happened but all his surgeries were canceled. Then once they got back to rescheduling it was aBIG hassel and run around and the DR and his staff turned almost mean, so I walked. So here I sit and wait once again trying to find another surgeon.
Robin O.
on 3/13/08 3:28 pm - Sheppard AFB - Wichita Falls, TX
Topic: RE: Wiliford Hall, San Antonio
WOW, thank you very much! I wish you all the best with your surgery! Let us know when you get home and all is good with you! I will have to check into it since I am in AZ which is TriWest. Hubby seems to think that should be ok as long as it is Tricare. I have been to 2 surgeons out here and I am just not comfortable with either one. I can not see letting a surgeon do surgery on me that I am not comfortable with. Will you surgery be Lap or Open? How is the baraitric staff at Wiliford Hall??
jennadweeb
on 3/13/08 2:44 pm
Topic: RE: Wiliford Hall, San Antonio
hi i am having surgery on tues at wilford hall. i am not comming from another state but traveling 3 hours one way to have it. i have talked to tricare and as long as you have the refferal, they will reinburst your travel, food and lodge with recipts. so thats what i am doing. if you have any more questions or want to know more feel free to pm me. jennifer
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