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Tricare drama, Queen of Denial

I started this journey by filling out a form from a local surgeon and going to an informational meeting. I have Humana insurance but there is an exclusion written by my employer for weight loss surgery. Tricare is my secondary, and their requirements are being 100 lbs overweight with a comorbidity, or being 200% over ideal weight. I knew that I was borderline with the 100 lb overweight requirement, but I jumped into it anyway. Took the test, was poked and prodded in every orifice of my body. Went to meetings and researched and read everything I could get my hands on. Once my surgeons office submitted the paperwork, I felt pretty sure that I would get approved. I was just a few pounds under. Then I get the big fat DENIAL..and the letter stating that I meet the comorbidities, but am 6.5 UNDER their requirement! So, I have eaten everything I can get my hands on! I feel bloated, greasy and FAT...so I went in today and reweighed...and weighed 6.6 lbs OVER their number! YES!!

Here I go again...the waiting...the checking the Tricare site every hour.

My new diet and lifestyle starts today, with or without the band. I pray that I get approved and can get banded soon. Would love to get off of blood pressure meds and off of that darn CPAP machine!

Will it be just another diet, or will I get on the bandwagon?

:party:

4 Comments

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JamieNP

LAP-BAND Patients

I started this journey by filling out a form from a local surgeon and going to an informational meeting. I have Humana insurance but there is an exclusion written by my employer for weight loss surgery. Tricare is my secondary, and their requirements are being 100 lbs overweight with a comorbidity, or being 200% over ideal weight. I knew that I was borderline with the 100 lb overweight requirement, but I jumped into it anyway. Took the test, was poked and prodded in every orifice of my body. Went to meetings and researched and read everything I could get my hands on. Once my surgeons office submitted the paperwork, I felt pretty sure that I would get approved. I was just a few pounds under. Then I get the big fat DENIAL..and the letter stating that I meet the comorbidities, but am 6.5 UNDER their requirement! So, I have eaten everything I can get my hands on! I feel bloated, greasy and FAT...so I went in today and reweighed...and weighed 6.6 lbs OVER their number! YES!!

Here I go again...the waiting...the checking the Tricare site every hour.

My new diet and lifestyle starts today, with or without the band. I pray that I get approved and can get banded soon. Would love to get off of blood pressure meds and off of that darn CPAP machine!

Will it be just another diet, or will I get on the bandwagon?

:tongue2:

JamieNP

LAP-BAND Patients

Update:

If you couldn't tell, I got approved after gaining the 6.5 lbs and resubmitting the new wt.

chubb32

LAP-BAND Patients

how much did you weight berfore or what was you bmi? I am waiting for an answer from tricare myself. I have a bmi of 38.1 and I have high colost and serv arthritis in my knees and back. I hope the let me do it. I don't know what I'll do if they don't approve it.

JamieNP

LAP-BAND Patients

Tricare does not go by BMI..just weight and they use the metlife height/weight chart for med frame build. I weighed 222..just 6.5 lbs under the requirement. I gained the weight (weighed 233 ) and got approved..by the way..I way 165 now...2.5 months after surgery.

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