Adrea

so my BMI was only 35 but i've been struggling ever since i was a kid! so my primary doctor wrote a real good letter to my insurance company stating all the diets and all the fitness, gym and alllll other things that i have tried so far. i actually got 2 letters from my primary doctors and send those in ... it TRUELOVE help and i was just approved!

in a way put yourself in the Insurance shoes and try to convince yourself why they should pay for your surgery. you have provide evidence and make them to realize that you NEED to have the surgery it's not a WANT.

my whole packet was about 50 pages of all kinds of receipts, gym memberships , Lindora, Weight Watchers and whole other diets that i've tried so far.

good luck! : )

Who is your insurance provider

I just opened a letter of approval from my insurance company!! I hadn't opened my mail in a week and there it was. I kept waiting for the dr.'s office to call and they still haven't. It looks like the approval was made the day after my original appointment! So I guess I will call tomorrow and find out the details...excited and yet nervous!!!!

Thats awesome,. how exciting! I would have been checking my mail everyday lol! Good luck:)

Adrea & Adrienne,

I JUST got approved literally last week so I haven't met my surgeon yet. I think you'll both get approved, if I got approved with Tricare Prime you guys will too! Good luck dolls!

So your referral to see a surgeon has been approved or have you been approved to have the actual surgey?

Girls! You have just made me so happy!!!! I'm a military wifey as well (Ft Bragg) and was considering wether or not to talk to my doctor about surgery. I was scared I wouldn't get approved. I'm 100+ overweight and have a BMI of 42. Ya'll just put my fears at rest so on 1/11/11 when I go to my doc I'm gonna ask her about it!

Good for you! Let us know how it goes. I can't go for 2 weeks and I am alreadys super nervous!

Good Luck! Let us know how it goes!

I got the call today, I was APPROVED! after all these months, after doing one thing after the other, after hanging in there without losing hope, my surgery date is going to be on Wednesday, January 12th! I am excited and scared, it's like reality finally hit me. I was rushing through the seminar and surgeon visits, then the 3 months diet, then all the exams, getting everything ready for Tricare, getting the clearance from my PCP, then the paperwork sent to insurance (2 nerve wrecking days!) then the call... Now it's just 5days on a liquid diet and I'm done. I'm getting banded... I really don't know if I should laugh or cry, I definitely feel like doing both!

Congrats and good luck!! I hope I can get approved!

I think a lot depends on the surgeon, and how they present the info to Tricare for approval. I'm told Tricare is one of the easiest insurance companies to get approval from (mine took just three days.)

As for being "strict," Tricare follows what Medicare says. If the code for approval is in the Medicare book, Tricare will follow it. Check with your surgeon to see how they deal with borderline patients. And when you get weighed in, wear heavy clothes and lead underwear. LOL!

Good luck,

Dave

LOL thanks where could I get some of those?Jk Well I have been talking to a girl on here with the same problems the same height as me but I am 30lbs heavier than her and tricare approved her so I have a little hope. I'm scared to ask my PCM fora referral though, I don't want him to say no:(

Adrea, it sounds like you have everything you need to get approved! I'm 5'5" and 200 lbs, BMI 32. I live on Camp Pendleton in CA, so good to meet another military wifey! My doc told me that sometimes Tricare requires therapy before you get approved so they can make sure you're motivated and stable enough for the lifestyle change. I was in therapy when I was younger so I think that had something to do with me getting approved. To be honest I did wear heavy clothes when they weighed me because most days I'm around 196-197 but after I eat a big meal I'm 200ish, so I wore heavy clothes so the scale would read 200. I think with the info you told me there's no reason you wouldn't get approved!

Good I hope so! I guess I'll find out in a couple weeks. I see a counselor everyweek maybe she would write a letter of recommendation and the chiropractor too. When is your surgery?

There are people here on the forums who have put on weight in order to qualify. Not getting in to the ethics of that, just letting you know it is an option.

Additionally, the FDA will most likely soon be changing the qualifications for lapband from a BMI of 40 to 35. You may soon find yourself being eligible.

Good luck!

Yeah since I have been home for the holidays I am pretty sure I have gained weight. I saw that FDA was considering approval for lower BMI hopefully insurance will follow Tricare seems strict but I have read of people on here not meeting tricares requirements and still getting approved so I am hoping I can be one of them.

I am right outside of Jacksonville - close to the coast! Have you had the surgery already?

Hello! I am just starting the process, I am from Jacksonville too! Who did your surgery? Are you happy with it?

Hello everyone! I have spent many hours researching lap band and reading hundreds of posts and I have decided to go ahead and try to get approval for the surgery. I have been over weight since I was 5 years old and I am SOOO sick of it!! I have tried alli adkins weight watchers results sort and sweet 20lbs gone 30lbs back. Problem is I have tricare and I know I don;t meet there requirements my BMI is almost 40 but not quite I am not 100lbs overweight for my body type and I have no comorbs that they list, I am however very close to 100lbs overweight have Reflux, Chronic back pain and depression from being overweight terrible family history of just about every comorb, heart attack, stroke, diabetes, congestive heart failure, sleep apnea, colon cancer, arthritis. So hopefully all this will be enough to get approved, I am praying for a miracle! I did not enjoy my childhood because of my weight and I refuse to have the rest of my life run by my weight. I may need some help but I am motivated to get it off!!. I am open to any advise or suggestion!

Adrea, I'm doing this on my phone so I don't know how to reply to you directly but I hope you see this! I was honestly surprised I got approved because I'm not 100 lbs overweight, but if I got approved this easily I'm sure you will too! My advice is just go for it! Talk to your doctor and try to work something out. Tell your doctor about back pain and let him/her know you're motivated to lose weight. I'm sure you'll get approved! Best of luck!

If you don't mind me asking whats you height and weight? I think my BMI is 38 or 39 I am 5'5 or 5'6 with shoes and around 233 normally. I am sooooo happy you posted I am going for it I'm kinda a chicken I am affraid my PCM won't get me a referral and I will probably cry like a baby. I am at home visiting for a month because my husbands deployed so I won;t be able to go see my Doc for another 2 weeks so I am trying to get some extra stuff together while I am here. Yesterday I went and got my records from the doctor I had when I was younger to prove I have been overweight for so long. I also have a family history of just about everything hopefully it will help. I'm praying for a miracle. What region are you in for Tricare?

I got approved with a BMI of 32 with back/hip pain and acid reflux. I have Tricare Prime which I've heard from many people including my doctor that they're very easy to work with. I told my doctor about my back and hip pain, he already knew about my acid reflux, and about my attempts to lose weight. I got approved in about 20 days, which was a long time because I started the process right before Christmas & New Years. Good luck! I really hope you get approved!

Girl you just made me so happy! I know I don't meet tricares requirments but I decided I was going to go ahead and try anyway. I have the same problems as you but my BMI is alot higher, I am not 100lbs overweight though and I don;t have any comorbs that tricare lists I had blood work done about 5 months ago and the doctor said everything was fine so then I was to affraid to ask for a referral. YOu gave me some hope though! Any advice?