AZArmyWife36

It's been two days and I' haven't felt too different. I have lost 16lbs and no gains. I wasn't too hungry but made sure to get my Protein and liquids in. I'm hoping that I'll feel restriction soon. Thanks to everyone for their input! I truly appreciate it! Keep on losing and getting healthy! :0)

Greetings fellow bandsters! I'm five weeks post-op and had my first fill today. My doc didn't waste any time and filled my band with 5cc's. I've been doing liquids all day and have had no hunger. I just wanted to thank everyone for the great information on what to expect throughout this journey! Wishing everyone lots of continued success!!

Thanks for the support! No gas pains for me! Relaxing and getting rested.

I had my surgery yesterday and today I woke up feeling good! Luckily the nurse massaged my shoulders and got rid of the gas. This morning I had a bit of Jello and now some Decaf coffee. I'm so exctied about my new life. Hope I'll be losing soon! Best of luck to everyone!

Tomorrow is the BIG day! I've been denied and denied that I can't believe it's here. I've been having some wild dreams! Is it nerves or just knowing that I'll finally be banded? Does anyone have any words of wisdom? I hope that everyone's surgery has gone well! To those that will be Halloween Banditas, best of luck tomorrow! We'll all be losers! Ha! Take care!

Hello to all!

Got my date for my long awaited lap band! Oct 31! Looking forward to a healthier me! Good luck to all!

Brenda

Hello All,

I am new to this forum and I have questions regarding getting approval for the Lap Band by Tricare Prime and I am hoping that someone out there can give me some insite on this because I am starting to get discouraged. My first question is I was told by the nutritionist that because my BMI is 38.6 Tricare will prob deny me. But I thought that as of 03/16/2011 Tricare Prime was approving the lap band if your BMI is 35-40 with one co-morbit. Has anyone with a BMI under 40 been approved by Tricare Prime? My other question is the insurance coordinator at the surgeons office stated that Tricare is the hardest insurance to get approval from and that there is a chance that Tricare will approve me but only if I go to a local MTF for the surgery she explained that this has happened to other Tricare patients in the past. My local MTF is Balboa hospital and I would prefer not to go the there if I didn't have to. Has anyone been approved by Tricare but only if they go to a MTF for the surgery and not to a civilian hospital?

I as well was just approved with a BMI of 35 with one co-morbit with Tricare Prime. I've been denied 3 times and with the new ruling I was approved the day after it was submitted. No MTF here at Huachuca. But I bet if you look into it more you'll be on your way to getting approved. Best of luck!!

I am glad that you have been approved because I have the same situation my BMI is 38.6 and the nutritionist told me that I would prob be denied because I have to have a BMI of 40 + one co-morbit, but now I see that is not true. One other thing I was also told by the insurance coordinator at the surgeons office that because they are civilian there is a chance that Tricare might come back and say that they will only approval the surgery if I go to my local MTF to have it done. Do you or anyone else reading this knows anything about this?

Hi! I have Tricare Prime. I went to my PCM on post and she gave me a referral to a bariatric doctor off-post. I saw a nutrisionist and did a pysch eval. Plus you should have some form of weight loss program you followed. I did Jenny Craig and HCG. Never did anyone say that I had to go on post or MTF to have it done. I'd call Tricare and ask about it. Good Luck!

Hi! AZ here! I'm seeing Dr. Monash in Tucson. Amazing team and the BEST doctor around!! Best of luck!!

Winner!! Tricare has finally approved me! The new requirements have taken affect. They no longer use that crazy MET life chart. They'll be using your BMI. I have been denied at least three times and now it's my time! Good luck to all! Get healthy and be happy!!!

Hi! After three denials from Tricare Prime, I'M APPROVED!!! Tricare approved me by the new BMI requirements. I didn't meet the old requirements because I wasn't 100 lbs overweight. My BMI is 35 and I have hypertension. Best of luck to everyone!!!

Great news! Tricare has new rule in manuals. New rule should be in system at the end of the month. You should be approved if you have a BMI of 40 or 35 - 40 with one co-morbidity. Not too sure what else is required. Keep your eye on it! Good Luck!

Wow! Thanks to everyone that has replied! I love the passion and sincerity of everyone! My BMI is 35 and the new rule will cover BMI from 35 - 40 and above. My doctor is one of the best and has done everything to help me out. I'm going to wait another month and try one more time. I heard from someone very helpful today that the new ruling might take affect at the end of July. So fingers crossed! Again, thank you for all the support! Many losses to all and happy lives!!

Sorry that they denied you. Glad that you are able to convert to self pay.

Thanks so much!

Well, here I am with a sad look on my face! Tricare denied me again. I didn't meet their requirements even though I have hypertension. My BMI is too low. So, hubby and I looked into it and we are paying out of pocket. I figure I probably have spent at least 10K in my lifetime on diets. So, my pre-op is Tuesday, 28 June and if all is clear and okay then my doc's office will schedule surgery. Wishing everyone luck on Tricare approval! I was hoping with the new rule that I'd get it approved. No luck! Best to all!

I'm in the same situation you are in. I happen to be very short 5'1". With the Metlife table I do not meet requirements per current Tricare requirements if they went off BMI I'm at 37.4. Go figure. They are changing to BMI effective 3/16/2011 per conversation with Medical Director for Tricare Dr. Barry Cohen. He also told me they are going to start requiring documented history of weight loss attempts and history of obesity. He said the new policy should be on the Tricare site in a few months. For now you can go to the following website for the information. http://federalregister.gov/a/2011-3207 I'm planning on going to my PCP this week with the new BMI requirements before Tricare changes any other requirements on their site. Keep me informed of your progress. Interested in others success with the new BMI change.

Wow! That's amazing! Thanks for the info! I have an appt with my PCM on Monday for referral. I'll keep you updated! Good Luck!!

Well I ended up gaining 10 lbs and then tried again, got approved no problem. They also switched my stats from a medium frame to a small frame. It looks like mid-March they are switching to the BMI method, that will be much easier.

Hi,

I was denied twice from Tricare a couple years ago. Where did you hear about it being switched to the BMI Method? Any information is greatly appreciated.

Thank you,

Brenda

Spoiltmom, I hope it's something else! Wish me luck!

Hi! I do not know why I was denied. I just checked Triwest and it said not approved. I think it's because I'm not 100 lbs overweight. I do have hypertension. I called the doc's office and they don't have anything as of yet. Sucks! I'm totally bummed out! I'm planning on appealing once I find out what the reason of denial.

Hello!

I'm soooo bummed out right now! Tricare didn't even take a look at it. It was submitted yesterday and denied today. Anyone have some appeal letters? Any help is greatly appreciated.

Thanks!

One sad girl :scared2:

Thanks so much for the words of advice! Fortunately, I do not have sleep apnea. I had a sleep study in 2008 and everything came back okay. I do not want to gain anymore weight. Maybe I'll just wait for some kind of change in Tricare's policy. Thanks again! :thumbup:

Hello!

Here we go again! Looks like I'd have to gain 22 lbs in order for insurance to pay for surgery. Spoke with the doc and he doesn't think it's a good idea to gain the weight. My other option is to self-pay and it's about $12K. Not sure on what I can do?? Not even sure Tricare would cover the fills and office visits. I'm so frustrated and angry! Anyone have any suggestions? Thanks in advance!!!

BB

Best of luck! Think positive! It'll happen!

Hello!

My efforts in getting banded in 2008 failed. I was denied by Tricare because I wasn't 100lbs over and had no co-morbidities. I know have high blood pressure and hopefully my insurance will approve. I'm waiting for referral and will see doc soon. Wish me luck!

Good luck to all!

BB

I just got denied today too, what was the reason for the denial?

I'm over 100 lbs overweight and I have sleep apnea, which I think is a comorbid..

I'm soooo upset.

I do not know why as of yet. Sorry that you were denied. Is it the first time? If so, make sure you appeal. You can have your PCM help you out. Best of luck!