aculberg

JWRN - Thanks so much for that! I see that youre getting your EGD today, good luck! I had that done, and turns out I have a hiatal hernia...I'm still waiting on my surgeon's insurance specialist to get back to me about the clinical info that Tricare still needs...but I'm preparing myself for a denial just in case. I'm not gonna stop fighting for this! Thanks so much!! :smile:

It looks like were having the same problem! I havent been denied yet, mine still says pending but I'm preparing myself for the worst. I too called Tricare and they said they needed more clinicals, that was Fri and my Doc's office was closed by then. I'm calling them first thing this morning to get them to fax whatever else they need! Tricare only gives them 10 days to get the info back to them or else they will deny it. I'm preparing myself for an appeal though. Your thyroid does fall under hypothalamic disorders, I believe. I looked it up. And diabetes definately does. Please let me know what you come up with for your appeal, because alot of our stats and co-morbids are the same. Good luck, let me know!

Hilbean - Were actually in the same city?! lol I'm so sorry to hear about your troubles, I would love to know the whole story. Esp since were seeing the same surgeons office. How do you like Dr Richards? I went with Dr Cottam b/c Richards was out on some medical thing when I started this process. I really like him, and have never met her, but have heard great things. Any insight you have with Tricare, like appeals, etc would be wonderful. Let me know how it goes.

Any letters and ideas you have would be soo great! I'm wondering whats going on with Tricare, at first I heard it was soo easy to get approved and now it seems like everyone is getting denied! I will pm you my email address. Thanks so much!

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...:cursing:

So, this is soo frustrating!! Apparently the surgeon's office submitted to Tricare on Thurs, so I check it online today (Fri) and it says "pending review"!!!! I have to wait ALL weekend...ugghhh sheer torture!! I almost wish I hadnt checked it....sigh....the waiting continues!

You can eat hard boiled eggs, string cheese, cottage cheese, lunch meat rolled up, veges and low carb dip, salads with meat and cheese, tuna salad stuffed in a tomato, chicken salad, there is low carb yogurt, which is actually really good! There is also low carb bread, Sara Lee Delightful Wheat. You could have shrimp cocktail, fish, lobster, etc. There really are alot of options. There is a low carb thread in the food and nutrition forum, check that one out, there's alot of good ideas on there. Good luck!

I, too, need my gallbladder removed, my lapband surgeon called me yesterday and said mine wasnt functioning after a HIDA scan that he wanted done. He said in his opinion its better to do the lapband first, IF youre not having any problems with gallbladder pain, etc b/c after you lost a bit of weight the gallbladder surgery goes easier so that the liver isnt in the way. He said he couldnt do both at the same time b/c of risk of infection and something to do with bile... But if youre having alot of problems, definately have the gallbladder out first. I know it sucks to wait, but your health is first and foremost.

Lotsawater - No surgery yet! I had to have a few tests done, turns out I have a hiatal hernia that he can fix when he does the lapband, and gallbladder probs that have to be done later. I ended up seeing Dr Cottam b/c Richards was out for a while when I had my consult. I just barely got everything turned in so Jill can submit it to insurance, hopefully today or tomorrow!! I'm keeping my fingers crossed! How is your journey going? Thats great that you actually have a date! You'll have to let me know how your pre-op goes. Its nice to know someone who is dealing with the same office!

Those of you that have been denied - did they say why? Maybe its just something easy like lack of paperwork? (thinking positive!) I am soo terrified of that happening to me, after all the tests and hoops I've had to go through....I would definately appeal it, it will take longer, but then you'll get their attention and say "hey look at me" Good luck!!

Hi there, I'm Amie, 33, three children, stationed at Hill AFB, UT. My husband is an F16/F22 crew chief, weve been here way too long (8 yrs) and are trying to make our way to Tyndall AFB in Panama Cty FL. Weve been married just over 15 yrs and he's been in for 15.5 of those! This is so great!!

Hi All! I'm in the process of going through the steps to get insurance approval, and I did the whole low carb/high protein diet last year, and it really does work, but sticking to it is hard, which is why I am here now! One question, where do you find the ketosis sticks? I havent tried looking for them yet, but will this week. Its great to be part of this group, and keeping each other motivated is what its all about!!

I just had my initial consult on Wed and it wasnt so bad at all. I met with the surgeon, he weighed me, we talked about the lapband, I am trying to go through my insurance, so we talked about what comorbidities I have, he did a quick little physical, pressed on my stomach, etc and that was it! Oh, he did schedule just 2 tests, an endoscope to make sure there is no damage to my stomach, and a scan on my gallbladder. After that I met with the nutritionist who talked about the pre-op diet (all clear liquids for a week!!) and what I should be doing now to prepare. Then I met with the insurance specialist and got all the paperwork going for that. Pretty easy, took a couple of hours, but all in all pretty painless. Now, I have to meet with the Psych for the eval and then get those 2 tests done, all my pre-op bloodwork and a pre op physical and then all should be done on my end. My only advise is to be really prepared with all your paperwork done and all of your medical records. I know, it is scary! And exciting at the same time. Good Luck!!

I am seeing Dr Cottam, had my initial consult with him yesterday! I was supposed to see Dr Richards but she is out indefinately... He does seem very qualified, and I found him to be quite funny! I feel very comfortable with him, I have to have an endoscope before being approved, and he told me to remind him to use the "thinnest" one so it wouldnt hurt so much!! The thing I dont like about their center is that they have 2 different offices, and its soo hard to get a hold of anyone!!

Thats great information, thank you so much! So now I know to make copies of the insurance requirements and copies of all the diagnosis' to show the insurance specialist.

Sounds like were all kinda in the same boat, as far as the weight part goes. I have my initial appt with the surgeon on Wed...wish me luck!! lol I too am interested in the sleep study, how does that work??

Hi everyone!! I am in the process of seeing my surgeon (Dr. Richards) for the first time next week...we are stationed up at Hill AFB so I'm trying to go through Tricare insurance for my surgery. Anyone else see Dr Richards or Salt lake Regional Med center?

Thats so great! I too am hoping to get approved with Tricare, have my initial consult next week, and then they will submit it all from there, I suppose...how was your experience with getting it all submitted and the consult with the surgeon?

Hi there - I am kinda going through the same thing...I'm about 10 lbs under the magic 100 lbs...I have read some things on here about wearing lots of layers of clothes when you weigh in and someone even mentioned ankle weights...kinda scary, but if it works! Its so sad that we have to already *have* problems, i.e. the co-morbids, instead of getting the surgery to be pro-active...sigh! But I am taking the risk and have my initial consult with the surgeons office next week...and just hope and pray that I get approved!! Any other info anyone can give would be great, even some examples of some people that did get approved under the 100 lbs just to have some references and some hope! lol

I know, getting a hold of them is next to impossible!! I have had luck getting Tina at the main number usually first thing in the mornings, but I tried calling this morning, and no luck! She did tell me that they were in the process of moving from 2 offices to 1, so sometimes they wouldnt be at the one number....its so frustrating!!

Choromom - Yay!! I am so happy for you. I have my appt on the 25th, so we'll see how it goes...how is the insurance coordinator at Dr. Richards office? Is she the type to work her butt off for you or just submit what she has to? Does she know alot about Tricare?? How did you know what your pcm put in for your referral? My doc on base just typed something into the computer and said "ok, its submitted" I dont think he wrote any kind of letter! You must be so relieved to not have to worry about getting approved anymore...:biggrin:

How did I miss this thread!? lol So, most surgeons are just taking people's word on their co-morbidities, and putting that in a letter to Tricare?? I thought they had to submit your medical records and all that jazz?? I feel like I'm right on the cut off to get approval, almost the 100lbs over, with hypothyroidism, high cholesterol, stress urinary incontinence...but nothing too serious! I meet with the surgeon for my initial consult in a couple of weeks, and might just have to fill my pockets up with quarters to qualify! :behindsofa: I really wish I knew just what Tricare looked at for the approvals...sigh

I called Triwest to see if Colledge was a network provider, and she isnt! Dang it! They did give me a list of providers that are, but I dont know if the surgeon's office will allow me to go to another psych for the eval. I guess I should try to contact them yet again, which is a pain!! And if the criteria is the same for Tricare Prime and Standard as far as qualifying for the surgery, then I guess I'll stick with Prime and just cross my fingers! Thanks so much for all your input.

Ok, so youre going with Tricare Standard, right? Have you figured out what your total costs will be? Also a big question for me is, with Standard, can you just have the surgery done, or does Tricare still have to approve it with the 100lbs overweight and co-morbids?? I have Tricare Prime and am nervous that they wont approve me b/c I am so close to the 100 lbs! I'm wondering if I switch to Standard, I know there would be some out of pocket, but hey, I'm already looking at $675 if insurance covers it anyways, with the psych eval and the $500 program fee!! If I dont have to jump through hoops with Standard, I'm switching!! lol

Choromom - I think I talked to you on another post! I have my initial consult scheduled for 6/25/08, youre also trying to go through Tricare, right?? So, how did your consult go? I know you said she's nice, thats who I decided to go with, I met Dr. Cottam at the seminar, but went with Richards in the end. What all did they do at your first appt? I am so nervous, and just hoping they really try everything to get insurance approval...did you have any experience with that? I really hope everything goes well for you, keep me updated and thanks for answering all my ???'s :biggrin: Oh also, did you have to pay for your psych consult, or were you able to get Tricare to cover that? They told me I would have to pay $175 for that on my initial consultation...