Question:
I am seeking Tricare patients with the same BMI or lower and no comorbidites

I am now gearing up to possibly fight a denial and this site has been so helpful so far. I need to find Tricare patients with a BMI of 42 or lower with no comorbidities that are listed in Tricare's handbook. These are diabetes mellitus,hypertension,cholecystitis,narcolepsy,Pickwickian syndrome(and other severe respiratory disease),hypothalamic disorders and severe arthritis of the weight bearing joints.My authorization is being held up because although I am 100% over my ideal body weight my co morbidites are not in this list. I have GERD, high cholesterol, migraines and joint pain associated with the obesity(per PCM's referal letter). Thank you in advance for all your help. I am looking to print this all out to be sent along with my appeal if it comes to that if not I will add it to my history of dealings with Tricare and WPA. Thank you again.    — S C. (posted on June 6, 2003)

June 6, 2003
Hello. I'm a Tricare Prime person... well thats my coverage anyway. Had my lap RNY in February. I just wanted to let you know that with GERD and joint pain you should be fine with the co-morbs... the high cholesterol and migraines will add to your cause. I had very similar co-morbs and was about 130# over ideal weight. I was approved on the first letter with no questions. My BMI was higher than 42 - but not by much.
   — Anne R.

June 6, 2003
I know someone who has tricare whose BMI was just at 40 or just below... She had no comorbs and she was approved through tricare with in weeks.. HTH
   — Catherine B

June 7, 2003
Hi. I also have Tricare Prime. BMI was 43, no co-morbids and I was approved on the same day. The whole process from PCP referral to surgery date took less than 30 days. I had GERD and joint pain, but my family history includes stroke, cancers (some of which are worse in the obese), heart attacks and a sad host of obesity related deaths. Keep fighting. Good luck to you.
   — TraciB

June 7, 2003
I am 9 weeks post-op LAP RNY.I have tricare prime and did not have one bit of trouble with them. To start with, I only dealth with the local Tricare office. I did not have my paperwork sent to the regional office like most do. I was told if the surgeon completed all the criteria, that the nurses at the local office could give the authorization. I was also very nice to the ladies, respectful. I think that goes along way. I had a BMI of 40 with NO comorbs listed in the hand book. I also had GERD and joint pain (not arthiritis). I made sure the surgeon stressed how this weight was affecting my quality of life as a nurse, mother, and wife. I was approved and had a surgery date within a few hours of the Tricare office getting the paperwork. I only called them once a week and always spoke the same person, again being very nice and making them feel like they were doing me a huge favor- thanking them alot for their time and effort. Because in all actuality- they were the one who were diecided my future. Feel free to email me if you have any more questions.
   — Jan S.

June 7, 2003
I am not 200% over my ideal body weight. By the metropolitan weight charts my ideal body weight should be 125. 200% of that would be 250 when I went on for my inital consult I was 236.7 I was hoping to qualify just from being 100% over my ideal body weight with GERD, high cholesterol, joint pain, migraines and family history. I was told this past week that my authorization was being held up because I do not specifically meet Tricare's requirements. I am getting prepared now for the appeal process and feel that if I can show where other people who were less qualified or with the same qaulifications as I have were aproved for this surgery I will have a better chance to get approved through an appeal. My surgeon's office has never dealt with and appeal process and the people here at my Tricare service center have been less than helpful with the whole surgery process all together so I can't count on them to help me at all with the appeal(if it comes to that) Thank you all for the responses anyway, I had read most of your profiles previously and had great encouragement that my story would be similar to yours but it hasn't been.
   — S C.