1000words

I was approved! My doctor submitted to the insurance on Wednesday, it showed up as pending on Thursday and was approved on Friday! I called my doctor's office and they don't know when he will be able to get to me... he begins doing the surgery on June 9 and is full on that day... not sure when the next surgical day will be. So hopefully I will be banded by mid-June.

I am taking Remicade for Rheumatoid Arthritis and Remicade causes a delay in healing. I was always told that you should wait to get any dental work or surgeries until you are due for Remicade and then wait for at least two weeks after the surgery to get another infusion. I know every doctor is different, but personally I wouldn't want to take remicade so close to the surgery. Even after I had a c-section three years ago my rheumatologist wouldn't let me have an infusion until the wounds healed.

Thanks for all your replies. Yes. Luckily Tricare and the doctor does not require a lot of extra crap to get the band. And, it is not that I could not wait for a few months... I would struggle through any hoops that I needed to jump through. My problem is that two and a half weeks ago I was told to expect to have the surgery in two weeks... and that time has passed and my file had not been sent to the insurance company... and no one has offered me an explanation. I am a worry wart and I am running through several scenerios in my mind... including that the doctor or the hospital has decided not to take my insurance for the procedure... since I know that topic was being discussed and they decided to take me as a patient and see what they pay before they decided to take more. And, I have been on the pre-op diet since my appointment.. no big deal just sugar busters. I am doing well and have lost at least 10 pounds. I agree that I might have to go ahead and get my Remicade and wait out another six weeks... I am just aggravated that I didn't go ahead and get it two weeks ago because I was told I would have my surgery by now.

I have a tendancy to overreact a bit... I am also not a patient person. So, I am hoping that a few of you might be able to give me advice on how to handle this situation. Basically I have been working towards getting the lap band for a few months. I was going through a local hospital's obesity center and everything was going great. The lady that handles the clinic was very attentive and quick to answer questions and phone calls. I like her a lot. But, things have seemed to change there and I am not sure what the problem is. I had my evaluation appointment two and a half weeks ago. I made sure she had all the paperwork from my other physicians she needed and my primary had ordered the bloodwork. Unfortunately the day after my appointment, the lady that takes care of submitting items to the insurance company went on vacation for a week. She said she was going to try to have everything ready for her assistant to send to the insurance company while she was gone, but she didn't finish the cover letter. So, my file set on he desk for the week she was gone. She got back over a week ago, but when I called her she told me that I was number 5 on her list of people to finish and she probably wouldn't get to me until last Monday. Nothing was submitted last week... after I left several messages she emailed me a one line answer saying she should submit it on Thursday. I called her office on Friday and spoke to her assistant who told me she was out of the office and would call me on Saturday. The assistant told me she was unsure whether or not my file had been submitted. Of course, no calls came on Saturday. Since I am tricare, she told me that we would probably get an answer the same day. I spoke with Tricare on Friday and they said that nothing is even pending in the system yet. She also told me at my appointment that I should expect to have my surgery in two weeks... now we are on our third week. I am not mad at the office, I am just confused. I am clueless how my file went from getting done in the day before she left to sitting on her desk for more than a week after she gets back. And if she ever called me and explained what the hold up was or that she was really busy, I would understand more... but the silent treatment is killing me. To make matters worse I have remicade infusions and I have to schedule the surgery when I am due for the infusion which is right now. If I get my infusion now I have to wait for another 6 weeks. Should I just sit and wait and not say anything else? Should I go by her office? The person that I am waiting to submit the approval is also the same person that does the fills. Okay, that was another long vent. Thanks for your replies.

I guess she either wasn't in the office today or didn't have time to answer her phone. I left a phone message and emailed her... still nothing. Called Tricare and they said there is nothing even pending in the system... so now I am even starting to wonder if it ever was submitted. I am sure I am aggravating the hell our of her, and I do feel bad for that. If she only knew that I was holding back and I really just want to drive over to the office and ask her in person. I guess I could truly be a stalker. I am trying to schedule a surgery around my husbands and my parents work schedule... and the weekend before the surgery I need to drive my son 10 hours away so my parents can watch them. When I was in her office on April 23 she told me to expect to have the surgery in two to three weeks. Well... this is week two and next week is three. Okay... well trying to be patient is apparently not working for me.

Thanks for all your words of encouragement. I sat on my hands all day yesterday to keep myself from calling and finding out if she submitted it to my insurance yet. I told myself that I could wait until today to check... unfortunately I have been tryng to call her all day without an answer. I just hate that things are out of my hands now. I tend to be rather a demanding person, but I am truly trying to work on it. The lady that handles the approvals has done nothing wrong, she deserves a vacation... I just hate that I got put on hold for it. On Friday she told me that I would be submitted by Monday, so as long as she submitted it I think it should show up either today or tomorrow. Keeping my fingers crossed that there are no more snags.

So, I have done everything I can and it has been up to my doctor's staff to get the authorization. Unfortunately the day after my appointment, the lady that takes care of submitting items to the insurance company went on vacation for a week. She said she was going to try to have everything ready for her assistant to send to the insurance company while she was gone, but she didn't finish the cover letter. So, my file set on he desk for the week she was gone. She got back on Friday, but when I called her she told me that I was number 5 on her list of people to finish and she probably wouldn't get to me until Monday. Since I am tricare, she told me that we would probably get an answer the same day... but I have been watching the website and nothing has shown up yet. I have been trying to call her, but there has been no answer. I know everything will work out in the end, but I am having such a hard time being patient. Okay, I have vented. I will now go back to stalking my Tricare authorization page.

My doctor puts the port on your chest (near you collar bone). It apparently makes the fills super easy. One person that I met has lost 100 lbs and you can't see where the port is, but you can feel it. She said you couldn't feel it until she lost weight. I personally like where he puts it. It doesn't seem like it would get in the way at all.

Congratulations on getting the referral! The referral process works a little different at each base. At one at my bases, the doctor put the referral in while I was in the office and it went through directly to Tricare(showed up within 2 days at Tricare). At my last base the doctor put the referral in and it went to the consult center at the local military hospital and if they didn't have an appointment or a doctor of that specialty it then went through to Tricare (showed up within a week). At this base the doctor told the nurse to do the referral and it went to another department at the clinic they referred the referral and then sent it to Tricare(took a week to make it through the clinic to Tricare). So, just be patient, but if it doesn't show up with Tricare in the next 5 business days I would call the clinic to make sure the referral went through. Congratulations again!

I agree. I think you either need to see your PCM again or take the steps to file a grievance. Tell you doctor that you want the referral then you will rely on the surgeon and his staff to evaluate you for the surgery. If they think it is a bad idea, then they will not do the surgery. Just be polite and firm about the fact that it is your decision. Let the doctor know that without his referral you will be forced to switch to Tricare Standard and pay more out of pocket. (since you would not longer need a referral) If he still refuses, see if there is a tricare service center or consult center at you base and ask to speak to someone there. Good luck, Kris

If you have good insurance that might pay for plastic surgery in the future, I would go to the doctor to get the rash documented. My insurance will pay for plastic surgery of skin folds if it causes rashes. :w00t:

I am so sorry to hear about your problems. My PCM was very understanding and supported by decision. If she wasn't I was going to go directly to the tricare office and put in the request for an off base PCM. What is your height and weight stats? Are you borderline for qualifying? What base are you at? I hate that a personal bias is going to keep you from looking into it. One option for you would be to change from Prime to Standard. You would have to pay a portion of the surgery out of pocket... but it might be worth it. (just make sure you choose a doctor that is covered by Tricare)

Did you have to pay out of pocket for the nutritionist appointment? I was told by my PCM that she would refer me to the doctor, but that Tricare would not pay for the nutritionist visit. Thanks, Kris

Okay... I have a question for all of you experieced lap banders. Would you let someone who has just recently began doing lap bands do your surgery? Apparently he is an experienced surgeon, but just recently completed his training to do lap bands. He is assisted by a surgeon that has been doing the lap band for 5+ years. Unfortunatly with my insurance only the new surgeon will do the lap band... the experienced surgeon will not. The weird thing is that the two surgeons do the surgery together... with one assisting the other. Either way both will be in the operating room. Advice please. Thanks Kris

minpin- Were you Tricare Prime or Standard?

Tricare question for Trell and others approved I am starting to go through through the process of trying to get the lap band. I noticed in one of your posts you listed that you were approved for the procedure before you saw the bariatric surgeon. Did you PCM take care of it for you? Do you see a base PCM or a civilian PCM? Also, I am looking at a local doctor (who is listed as a Tricare provider) to do my surgery... but his office said that they are still unsure whether they are going to take Tricare patients for Lap Band. Apparently they do not believe they will be paid enough. Who is your surgeon? Have they said anything to you about Tricare undercutting what they want for payment? Also, did Tricare prefer the "Center of Excellance" status? I go in April 14 to my PCM for a referral and I just want to make sure I go in prepared. Thanks