FRUSTRATED!!
Well, I finally made up my mind that I want the surgery (sleeve) done. I talked with my husband last night and told him I need his support. He said go for it! So, I had appointment this morning for a referral. He doesn't want to give me one! UGH He was like have you seen a dietician? I'm like I know how to lose the weight, I've done it tons of times but I gain it back. Have you tried adapex? Yes, I've tried and yes it worked until I stopped taking it. Yes, I've tried metabolife and it also worked until I stopped taking it. And I can't take those things because I have high blood pressure. He is like well your bmi is only around 35.....I said so what if I gain 10 pounds and then I can get a referral? And he is like well, I don't want to tell anyone to gain weight but.......This just makes no sense to me! He said its time for my labs so I go tomorrow and get that done and maybe that will give another reason for me to get it. Although he said something about calling the referral people and talking to them and would get back with me this afternoon. I told him LOOK I NEED HELP! If I have to I will go to Mexico for the surgery and I really don't want to do that. Ok, I just needed to vent!
Vent away!
WLS is a very emotional issue and when we KNOW it's what we want and need and others (especially Doctors) don't want to hear us or help us, it is very frustrating.
First thing I was thinking when you said this was "find yourself another Doctor". But - with a BMI of 35 you will have problems with insurance paying unless you have documented comorbidities, then you still may have a fight. If you intended on self-pay then I don't think you would need a referral. Just find yourself a good surgeon!
HW-218/SW-208/CW-126/ Lowest Weight-121/Goal-125 - hit 8/23/09/Height-5'3"
Regain 30 lbs from 2012 to 2016 - got back on track and lost it. Took 8 months.
90+/- pounds lost BMI - 24 or so
Starting BMI between 35 and 40ish?
Join us on the Lightweights Board!
What are your comorbidities? without them, doesn't matter how good a surgeon he is, you probably won't get insurance to pay with a 35 BMI. It may not be fair but it is the system we are in right now. Have you talked to your insurance? What are their rules?
Be mad but be constructive with your anger. See what your insurance needs. See what your Dr needs. We could go to an information session with no referral and that may give you a lot more information.
66 yrs young, 4'11" hw 220, goal 120 met at 12 months, cw 129 learning Maintainance
Between 35-40 BMI? join us on the Lightweight board. the Lightweight Board
I have high blood pressure, have been on meds for like 5 years. I'm 45. I did get the call that I got the referral! So, I'm excited about that. But, my friend saw her doc yesterday and told him about me and that I want the sleeve he said he isn't having much luck getting Tricare, our insurance to pay for the sleeve. UGH My husband does not want me to have the RNY and really I don't want it either. I'm going to call when they open and make an appointment to go talk to him.
Glad you got your referral. Weigh heavy that day, like coins in your pockets, heavy clothes and shoes, etc.
My insurance wouldn't pay for a sleeve and I was 40 BMI. They would only cover bands and RNY. I was afraid of bands so went with the RNY and have been very, very pleased.
good luck. I don't have any experience with Tricare but I think some of our group does.
66 yrs young, 4'11" hw 220, goal 120 met at 12 months, cw 129 learning Maintainance
Between 35-40 BMI? join us on the Lightweight board. the Lightweight Board
Trace, I think I chimed in once before on Tricare. But on this its a hard and fast, they will not approve the sleeve. http://obesitycoverage.com/tricare-weight-loss-surgery-requi rements/ Heres the link to what they cover. That said, with a documented history of High Blood pressure you mentioned, your BMI of 35 should be adequate also cited at the above link. Don't lose hope yet of being disapproved and if you are... resubmit by their own rules you should be approved.
Also, not saying the sleeve is better or RNY, but both have advantages and if the sleeve isn't an option, RNY may work for you...
I'm Jo 
HW 245, SW 236, CW 151 Yeah (Normal BMI!!!!)
M1=213 (-23), M2=201 (-12), M3=186 (-15), M4=175(-11), M5=166(-9), M6=157(-9), M7=153(-4)
I saw that yesterday when I was searching. The secretary at the clinic said they did pay if for some reason you didn't qualify for the RNY. But, I guess she was wrong. lol I'm going for my consult tomorrow. I'm going to have them send in the request for it any way. I wonder if you can fight it when they turn it down? I just don't understand why they don't pay for it.
I wonder what reason you wouldn't qualify for RNY anyway?
