miissxangela

has anybody been denied by tricare that can tell me how I submit the appeal? I have a letter giving me directions, but what I'm wondering is do I have to submit a letter to them as well as the appeal form? help:eek:I'm pretty bummed out.

wow! that is soo much! I didn't get an estimated wait time. All I had to do for WLSC is a psych computer test and psych consult. For tricare, I had to meet with a nutritionist, have a TSH and H-pylori lab test. Also I have to have a letter submitted by my primary care saying that I'm not addicted to drugs or alcohol and that i have no pulmonary or cardiac conditions and 5 years of medical history & physicals (basically anything charting weight). Once that is all done and IF *HOPEFULLY* I get approved by tricare, I will get my surgery date and I will meet with the surgeon, have to go to a 3.5 hour class on WLS and I believe that's it, then I'm good to go. Maybe NSG made you do all of that stuff, because of your comorbidities? I'm not really sure. And June, man.. I think it is definitely worth it to cross the bridge.. OHHH anddd! they will accept all of that stuff that you had to do at NSG and I'm sure you will get surgery quicker!

I learned about this in nursing school...and like the person above, nobody ever believes me!

ohh yeah I'm not about all that wait time. I was supposed to go to portsmouth naval medical center, but wait time there is 6 mos.... Wlsc fee is $750..so a bit more, but I think better than waiting!

I am going through Weight Loss Surgery Center in Newport News.. I think that's the one you're talking about. There isn't really a wait at all.. like as soon as you get all of your stuff done, you get an appt. with the surgeon and set a date after it gets approved by tricare. how long did it take you to get approved by them? Also how much is the program fee at NSG?

That's where I live now :grouphug: near Portsmouth (Hampton to be exact). It is a small world. I miss home so much!! I am in the process to get approved for surgery. So far, I have gone to a seminar, and I have my psych eval today. I am hoping to get a nutrition consult sometime next week (that's required by my insurance), then after I get that taken care of, my stuff should be submitted to my insurance and from what Ive been told/read my insurance only takes about 3 days to get approved so I should be getting a date then!! It feels like it's going to take FOREVER to get it done, but I'm just taking it one day at a time! How long did it take for you to get a date?

I took phentermine for a while a few years back. I lost 50lbs with that and a low calorie diet. The only thing it did to me was make me jittery. I was also taking b12 for some energy... overall, I didn't have that great of energy. Oh and I gained about 55lbs when I came off it. But then again, I didn't follow that diet anymore either.

Congrats on getting a date :grouphug: I'm still waiting for mine. I am from Central/East PA, but I live in Virginia currently, because my husband is in the Navy. Where are you from? I used to live in Lancaster County

I think Onderland is when you weigh 199 or less, but I could be wrong

Nursing major smurshing major... I, too am a nursing student, but that doesn't make me qualified to decide what is best for your health. The decision is between you and your dr. not some nosey girl who obviously doesn't know much about WLS.. I haven't been banded yet, but I can't wait to do it! I am 19 years old with a BMI of 40 so we are kind of in the same boat. Don't let ignorance get you down, I have had a fair share of negativity from people I care about and others who have just overheard a conversation and decided to chime in. Just keep in sight your ultimate goal of living a healthier life and undoubtedly, you will make the best decision for YOU. My suggestion, just keep researching, best thing you could do.

Thanks for your reply :sneaky: I went to WLSC today as well, but for the seminar. I am scheduled to go to a seminar at NSG on wed., but I don't think I am going to go. I really liked Dr. T much better than the surgeons seminars I've been to before. How long did it take you from your seminar to thursday (your surgery date)? I have tricare so I guess it depends on your insurance. Since you were self-pay I take it you got in pretttyyy quick. I have my computerized test scheduled for tomorrow morning I'm pretty excited to get started! Keep me posted on how things go!

Wow.. you are pretty much almost there!!! Hopefully your approval will come soon! Standard is only faster for me, because of the long wait at portsmouth... if i switch to standard, i will be able to go to a civilian surgeon. Tricare won't refer me to a civilian surgeon if I have prime, because I am near a MTF. Wish I wasn't though. I don't want to wait 6 mos! My husband is active duty Navy. Can't wait to make it to onderland! haha. I will add you as a friend on here so we can keep in touch!

cool that you lived here! I haven't had surgery yet, because Portsmouth Naval Medical Hospital has a 6month waiting list. I am currently enrolled in prime, but to speed up the process, I am going to switch to standard. I am going to a seminar in Newport News tomorrow so hopefully I will know how long it will take to get surgery then.. It seems to me that tricare has been pretty quick with their decisions (from what i have heard from other people).. I haven't had anything to get approved by them yet. Where are you planning on getting surgery? How far along are you in the process? Like have you gone to the seminar and met with the surgeron?

Virginia is actually the North Region for tricare...Where from in Virginia? I live in Hampton.

My husband is E-4 right now, he takes his test for E-5 next week though, but those results usually take a while.. I will have to research the amount of time it takes to get back on prime if he's E-4. I called tricare yesterday and was told the only thing I would have to pay for are, of course, the copayments and $14 to stay overnight in the hospital. There is a $750 program fee with the civilian surgeon that I am looking into, but no insurance covers that. I am going to a seminar next week for the civilian surgeon to make sure there aren't any other hidden fees to help better make my decision. I would like to save money, but in the same hand... I want last summer to be the last miserable summer of my life. It may sound stupid, but I'm sick of being the miserable fat girl that can't do anything/can't wear anything cute...and god forbid go to the beach or a pool. Ohh yeah, and POS is out of the question now.. it is way too expensive! Thanks to both of your responses!!!

Hey everyone... I am considering getting banded and I was checking around for a few places to go. I see a popular place is WLSC in Newport News. Just wondering if anyone has gone through Norfolk Surgical Group and how your experience was. I have read and heard a lot of good things about WLSC, but not too much about NSG. I have signed up for seminars for both next week. All I know so far is that NSG has a less expensive program fee than WLSC.

Hi everyone.. I currently have tricare prime, but was told there is a 6month waiting list at the MTF which I am assigned. I talked to tricare and they said the only way to get around it is to do Point Of Service just for the surgery..which I'm not clear on what that does... or completely unenroll from prime and switch to tricare standard. I understand I have to pay co-pays and what not, but i'm just wondering, after surgery, how much did you end up paying for hospital bills and everything?? I'm so confused and don't know if it's just best to wait 6mos. or if I should get the ball rolling and just get off my wallet. :thumbdown:

Hi... I have tricare prime north and WAS looking to be banded at a MTF but there is a 6 month wait! ... Anyway, I had to go to my PCM, get a referral which got sent to the MTF, then I had to go to a mandatory 4 hour seminar. They explained that they would call us and schedule an appointment for a consultation with the surgeon and from there the surgeon would decide if he wanted to operate, submit it to tricare and wait for the approval. After approved, I would have to attend a 1 hr appt. with the psychologist and nutritionists that are on base. After that I believe I would meet with the surgeon again and set up a surgery date..and i think thats all I know haha. Since there is such a long waiting list I am jumping through hoops to get treated by a civilian surgeon. Keep your fingers crossed!

a girl at my orientation asked about the mirena IUD...and the surgeon said that wouldnt be a problem...but i'd still ask

it has to do with blood clotting. even if your surgeon doesn't require it, I would still consider it!

Hey... I'm Angie..husband is in the Navy. I'm trying to get banded at Portsmouth Naval Medical Center, but the wait is 6mos long... anyone else have problems there/solutions?

I am in Hampton, VA... Who knows when I will be banded though! haha

haha thank you :rolleyes2: Do I need to have a reason other than I'm not waiting 6mos. for surgery to want to be referred out to a civi dr??? I'm hoping they are cooperative. But my luck, they won't be. Thank you for all your help and I will definitely let you know if they say no!

Just wanted to know if any of you tricare prime bandsters had problems getting in to a military hospital for surgery and requested to be referred to a civilian hospital?? I went to my seminar today and the waiting list to the hospital I am assigned is 6mos long!! All of the posts I've read about you folks with tricare prime got in within a few weeks. There are also no other hospitals in this area (Virginia/Maryland/North Carolina) that do bariatric surgery...unless maybe you know of somewhere??? Suggestions greatly appreciated!

I just got home from the seminar...and there is a 6month waiting list. I'm kind of upset. I think I am going to call tricare and see if there is anywhere else I can have the surgery