PCOS & Tri-Care Insurance Approval

Hi my name is Tara and I have started the process to begin having the lapband surgery. I have Tricare Prime. My PCM gave me a referral to see a surgeron to start the process. My BMI is 41 and I have sleep apnea. I also suffer with chronic pain in my heels and ankles due to this weight. I have saw the nutritionist, the physical therapy person, the psychiatrist I have done the upper GI, the lab work and went to the heart doctor, but I have yet to see the surgeron that will do my surgery. Do you have any idea how many more appointments I will have and when does Tricare say ok yes you are approved to have the Lapband Surgery.

 Aloha! My name is Mercedes I talked to my PCP and he gave me a referral to both a rhumey and a bariatric sugeon (I have Lupus... not a co-morb).  He said that I had a 1% chance of getting approved by TRICARE.  I left the office feeling defeated.   

My current BMI is a 37.1, not enough for my insurance to approve.  I'm SO fustrated b/c I know that WLS can help me on so many levels.  I have irregular periods,depression, arthritis, and chronic lower back pain.  Still not enough. 

Anyone have any thoughts on how I can get WLS w/o having to gain MORE weight?!!!

Hi, I am an Army wife from Ft Eustis Va. I have Tri-Care prime and I am in the middle of my "waiting" process for the surgery. This is how it happened for me. I went to my pcp's office and seen a family care doctor. I told her I wanted to look into the gastric bypass surgery. She asked me to tell her any type of dieting exp's I had had and how much weight I had gained since highschool and then asked about any co moridity's I had and YES they considered my PCOS a co morbidity! She put in a referralfor me a portsmouth naval hospital for a few weeks later ( called tri care and got the appointment ). Went to portsmouth naval for a 4 hour oriegntation where about 25 of us met with the whole team that only work on wls patients. Got all the info, did our weight, found out our offical BMI's and met the surgeon who explained through a slide show the different surgerys etc etc. Got a surgery number ...they do about 5 sugery's a week and this way you can look online at what number they are currently on and see how much longer you have ( most of the time you have a pre op in aout 6 months and then the surgery about 30 days after the pre op ) Right now while Im waiting the only thing I have to do is follow a simple diet plan given to me by my PCP and then get a few measurements and weigh in's to provide to the team on the day of my pre op. ( if you have done weigh****chers in the past for 6 months or more they take that as well ). I had my oreigntation in May and I should have my pre op sometime close to Nov. Good luck!! Any questions feel free to ask! Brandi~

Hi i was just wondering how things went for you cause i just had my pcp give me a referral to Portsmouth naval hospital to see someone . I have to wait till Wednesday or Thursday to call to set an appt . Do you have anything to tell me about your wait did you end up waiting six months ? I have seven months till my husband retires ..

I started my process about a month ago. Everything was pretty easy. My BMI is 49 with 1 comorbility. My referring doctor turned in all my paperwork last Friday and got the ok this Wenesday. I didnt have to wait six months or anything. You can email me at [email protected] if you have any more questions.

Hi, sorry to bother but i'm so compleatley lost on this. My husband just goined the army, but i had been looking at the surgery for years now. I'm 5'4 1/2 and weight  249. I dont have any co-mo . I do have PCOS, which is the reason why i can't get pregnate. I just got sent to a PCM. I live in the north region , in New jersey. On my first appointment  (6/15/10) she just did a check up but didn't ask me anything else or give me time to ask her any questions. I start Tricare prime on 07/01/10, and the PCM  tricare sent me to is a center, not a private office. the PCM they listed has different doctors working for her, so one of them attended me. So what do i do now? Were do i even start? Do i call tricare and ask them that i want the surgery? I wouldn't mind doing it in a MTF. I just dont know were there is one close to me. I'm sorry for the 100 questions, but i'm just so lost. How long does this whole process even take? Any information on were to begin would be extremely grateful. Once again sorry for all the questions.

Tori 

Well, first you should make an appointment and see one of the doctors where your PCM is, it wont matter which one. Then ask them for a referral for WLS (weight loss surgery). They will put in the referral and tricare will get back in touch with you (via mail) with a doctor and telephone number. Call schedule your appointment and go from there. I know for sure you have to have a BMI of 35 WITH co-mo OR a BMI of 40 WITHOUT any co-mo. But either way you should be able to get referred to a bariatric surgeon. If you qualify the process is fairly easy and goes pretty quick from my experience. Good luck and feel free to contact me anytime!!!

hello...its been a while...but since my last post, i saw a bariatric surgeon, had my blood work done, did the ultra sound, but they found out i had gallstones. i had the surgery to get them removed 2 weeks ago. The insurance then requested a clearance from a cardiologist and i did it last week. Now im waiting for the surgery aproval...and so anxiouse!!! oh btw my pcm screwed up the inital letter that was supposed to go to the insurance. She did not list that i had pcos or anything. i really dont know what my chances are right now.

I have Tricare Prime. I had my gastric bypass on 3/15/2007 at Fort Carson...for free. I am going through the process now of getting a tummy tuck through a civilian plastic surgeon in KS. The tricare office said they would paid for all costs associated with a panniectomy and I am waiting to talk to the plastic surgeon's office to see how much more for a full tummy tuck.

Starting weight was 302 lbs size 28+...went down to 185 lbs size 18....had a baby on 4/24/2009... current weight is 215 lbs size 20. My goal is to be under 200 lbs.

 I tried for an approval in Norfolk where we are stationed but because I lived near Portsmouth naval hospital that is the only place they would allow me to and after fighting for a year :( I felt so defeated. I have had awful experiences with military specialist, after being put on metformin for my pcos I found out I was allergic and was told by the fertility doctor at PNMC that if I did not take metformin he refused to help me and I should look into getting a gastric bypass, when I asked my PCM in Va for a referral he gave it to me no questions asked but when I tried to set an appointment for the orientation was told that they could not fit me in for MONTHS and at the time I had to go on a 2 year waiting list for the surgery but she added that because I had only quit smoking 3 months before I had 9 more months before I could even go on the waiting list. I had to get smart about it and wait until my husband deployed because every time he deploys I visit my family in Florida. I grew up in a small town hours from the nearest MTF. I am normally in Florida for the entire deployment so I changed my insurance from north region to south got a civilian PCM and after 2 visits with my new PCM I got my referral for a surgeon of my choosing. The referral was immediately approved by tri-care and I have my first appointment with Dr. Shebani this week. I am so excited! All that is required here in the south region is me seeing a shrink, getting blood work, and a dietitian. Shebani does not make me go to an orientation or seminar. And he worked with my first pick which was Dr. Jawad (who I found out does not accept tri-care anymore) for 5 years. I am amazed at the ease of dealing with the south region compared to what I went through with the north region. Also the smoking here in Fl not a problem. I have not smoked for 6 months now but here in Fl all the surgeons here require is that you stop smoking when you start the process and do not smoke for the duration of the process.