AZArmyWife36

Hi All!

Tricare denied me the first time and I appealed. I just went on to Triwest and saw that I wasn't approved again. Bummer! Really saddens me and it's horrible that I have to gain more weight just to get approved. I want to wish everyone the BEST OF LUCK through their WLS! I'll just have to figure out what I can do next.

Unhappy in AZ

Sounds like were all pretty much in the same boat here! Mine was submitted last Fri (the 25th) along with a fix for my hiatal hernia. Well, the hernia one is approved but the lapband still says "pending review"!! I got a letter today from Tricare saying they need more info from the docs office and only have 10 days to get that submitted, when the letter was faxed to them on Mon. So, here I am scrambling around to call the docs office (of course they dont answer) to see what all they still need. And I only have until Tues to get this all faxed back to Tricare!! UGH! They said they needed documentation of hypertension, even tho I'm on meds for it, and the list of meds I'm taking, plus lab work, etc. I had all the tests the surgeon requires and he found some scary stuff, the hernia, plus a non working gallbladder that will be removed at a later date, hopefully after the lapband. So, here I still sit and wait, until Monday, again, until I can contact the insurance coordinator, and get this all re-submitted!

AZArmyWife - what all did you put in your appeal? Any info would be great just in case!! Thanks so much...:wink2:

Hi! I went ahead and did my appeal on my PCOS and Asthma. I talked about my childhood and having to grow up being overweight. I also included some editorials on why bariatric surgery is helpful in PCOS and Asthma. Also, talked about my parents and their ailments. I checked Triwest and it shows Pending Review. I'm keeping my fingers crossed that it will be approved. If you like I can email you some appeal letters that were sent to me. Just let me know. Best of luck!

denied:frown:i have tricare and the dr office sent everything in yesterday and today i went on the web site and it said denied. i am 236 and 5'4 and thats 100 pds overweight by the met life charts and i have thyroid and pre diabedic!!! im so bummrd im calling in the morning for a reason any body else have them change approval after calling ?

Hi! I'm so sorry they denied you. I immediately called in and found out that customer service could not give me the answer. I had to wait for the letter in the mail. I did send my appeal last week and as of now have not had any response. I'm keeping my fingers crossed. Make sure to appeal it. If mine does go through this time I'll let you know. Good Luck!

I wrote 2 letters myself, one about the medical need and another about the emotional need. Then I asked every doctor who treats me for anything weight related to write me a letter of support. i.e. Gastrointerologist - GERD, GYN - incontenance (almost always weight related and mine went away quickly after), Podiatrist - ankles, feet, arthritis, GP - High BP and Chol. You get the picture. I then went back to the bariatric surgeon and had him write his own endorsement and they sent the entire package in. BC/BS called me directly and said she had never read such a letter and approved me and wanted to tell me directly.

I'll share with anyone who wants it, just give me your email address and I'll send them your way!

Good luck!

Thanks so much! My email is cafe15@yahoo.com! Have a GREAT Monday!

APPEAL. BC/BS denied me the first time through too. Get a letter of support from any doctor that treats you for anything that would improve with weight loss, pediatrist, GP, Gastrointerologist, etc.

If you need sample letters, I'd be happy to share mine, just PM me.

Hi! I was denied by Tricare as well. I'm not sure on what I really need to do for the appeal. Did you write a letter yourself or did your PCM provide you with one? I'm not 100 overweight but I do have asthma, PCOS and high blood pressure. Though I'm not being treated for the high blood pressure. Any information is greatly appreciated! Thanks so much! Brenda

Thanks soo much! I truly appreciate it! Good luck on your journey!

So, I just returned from a fun four-day weekend in Vegas! I lost but had a blast with DH. I hadn't been online until this morning and saw that Tricare Prime has denied my approval. :biggrin: I can't believe how upset I am. I have a 35.6 BMI and have asthma and PCOS. I did a sleep study a week ago but those results haven't come through. My question and I'm hoping for some help is . . . has anyone appealed? Any pointers on how to get APPROVED? All help is greatly appreciated. Sad day for me. Thanks so much! Just me, Brenda B.

Yeah, I thought about putting a few extra heavy things in my pockets! I didn't even have to meet with my pcm...the office is writing the referral now. woo hoo!! With clothes on I am about 5 lbs under the low weight/small boned..with 2 comorbidities

Hi! I as well have Tricare and do not meet the 100lbs overweight. I have a sleep study scheduled this weekend and after that it'll be submitted to Tricare. I'm hoping I'll be approved. I was curious about the sleep study. Any information is greatly appreciated. Thanks!

Lol...I'm such a kidder!

I'm in the process of getting approved...had a setback because my psych eval said that I need to wait until my husband comes back from Iraq to have the surgery...so it'll be like 6 more months until I can do it..

Just thought I'd introduce myself though. I'm a mother of 2, full time college student at Kansas State University, and an Army wife (which means I'm on tricare).

So HELLO EVERYONE!

Welcome to the boards fellow Army Wife! I as well have Tricare and still have to do a sleep study before it gets submitted for approval. If you need any help please don't hesitate to ask. BTW, hubby is from KS. My step-son graduated from KU last year and my youngest step-son graduates from Washburn in Topeka. We are headed out in December. We can't wait! Best of luck!

I just got a call from my case manager at Triwest. I am approved!

Next step is to connect with the surgeon's office, which should be a little easier now that I just need to make an appt for a pre-op, instead of trying to talk specifically to the insurance coordinator. I was told at my initial consult that surgery is usually within two weeks of that, but there have been vacations for the doctor in June, so she may be scheduled farther out.

This has been an emotional roller coaster for me, from the day I first found out that Tricare would cover a lapband! Right now, my hands are shaking.

I don't think I have any unrealistic expectations. I'm anxious, and eager to get this taken care of. My sweet husband is supportive, and is already thinking of ways to shop and cook that will accommodate my needs. I admit that I've been enjoying some foods that will be off limits after surgery, but that will stop now, and I will stick with the salads and fresh fruit that are already in the refridgerator.

I've stopped drinking colas...three different times! That one will be hard, but I know I can do it. I stop, and am able to stay away from it for days, then when no progress is made towards approval, I indulge. So, progress is made, and I will stop caffiene!

I guess I'll go check out the ticker site, and finish my personal profile!:smile2:

Congrats, Congrats! I have Tricare Prime (AZ) and awaiting to have a sleep study done on the 27. After that I'll have my psych eval, doc's eval, infertility and sleep study submitted for approval. I'm not over 100lbs so I'm hoping the two co-morb's will help out. I'm getting super anxious! My hubby is active and has two years left for retirement so I'd like to get this done sooner than later. Best of luck to you!

Thanks for the info! I haven't been approved as of yet. Fingers crossed it'll happen. I'm super nervous and reading your post has helped. Thanks again! Best of luck on your journey!

:tt2:Hey everyone I got banded on March 13 07 and have lost about 92 pounds. Went and got third fill done 2 weeks ago and found out last week I finally am pregnant. This is a wonderful thing since due to my weight I had polysistic ovarie and was unable to concieve children so yes there is hpe. But how long should I wait has anyone else gone through this?? How long do you have to wait after having the baby before you can get your band tightened again??

Congrats! I'm so happy I've found your post. I as well have PCOS and have not been able to conceive. I'm hoping to be banded in the near future. Best of luck! I bet you are sooo happy! Congrats again all around!

Welcome to the forum Brenda! What an odd dream. Ok - let's interpret it. The IV part probably indicates that you are nervous about having an IV. Don't worry - it's nothing (but you might ask if they will put it in your arm instead of in the back of your hand - less painful). Then the part where you go into surgery and have to put on scrubs....that part probably means that you are anxious about a procedure where you won't be in control and you really wish you could be one of the people in charge, instead of the patient?

Or, maybe you just had too much wine with dinner the night before! LOL!

Best of luck to you, and enjoy the forum.

Thanks so much for your interpretation! I loved it! I'm really enjoying this forum. It's the Best! Have a GREAT weekend!

Fingers crossed! I hope everything works out for you!

Thanks so much! I truly appreciate it!!!

Greetings from Sunny AZ!

I have to start off by saying that this site ROCKS! I have enjoyed all the different threads and support. Thanks to everyone!

Last night I had the craziest dream! I had been approved and was getting ready for my surgery. I had a nurse that shoved an IV in my arm and left me standing alone in a room. Then I found myself walking into another surgery that was being performed. Before you know it the nurse gave me scrubs to put on. That's the jest of it. I haven't even been approved and here I am having these crazy dreams.

I've never had any surgery of any kind. Can anyone please give me some advice? Thanks so much!

Keep up the great work!

Just Me, Brenda B. :biggrin:

I got my consuld approved to see Dr. weiner in FrankFurt Germany. Now TRI Care can still deny the actual surgery, but im keeping my hopes up because they said it was almost impossible to get them to approve a consult. So im hoping im going to get approved. I go see Dr. Weiner on Memorial day because germans don't Celebrate the holiday and are business as usual..Of course my company is closed so i won't have to take any time off work to make the 2 hr. drive(one way) up their. ohh geesh im soooo freakin excited.:biggrin:

Hi! Best of Luck! I'm in the same boat. I have my first consult next Wednesday in Tucson. Where are you located? We've been back in the US for a year. We lived in Heidelberg for 4 years. What I would do to go back! I truly miss it! I'm assuming you have Tricare. I hope I get approved. I'll let you know if I run into any snags along the way. Have a great one!

I didn't think the pain was bad at all, the worst part is the bloated tummy, I walked and took gas x thin strips, that really helped. The first two weeks were a piece of cake for me, I am struggling with hunger now. Good luck :frown:

I do have this fear about going under. I've never have had any kind of surgery. Any advice on how to calm my worries?

The first couple of days are hell!!! I didn't expect to be in so much pain. I kept asking myself what did I do?????? but it get's better each day. I'm in Tucson and went with Dr. Schwartz. I lost 10 lbs on my 2 week pre-op diet, it really gets you ready for what's ahead. Just remember try to drink and walk, it helps with the pain. When are you getting banded????

Hi! Greetings from Ft. Huachuca! I have my first consult next week with Dr. Schwartz. I haven't gotten approved as of yet (Tricare Prime) but will be meeting with him. How was your overall experience? Any information is greatly appreciated. Thanks!!! :cursing: