JamieNP

I started this journey by filling out a form from a local surgeon and going to an informational meeting. I have Humana insurance but there is an exclusion written by my employer for weight loss surgery. Tricare is my secondary, and their requirements are being 100 lbs overweight with a comorbidity, or being 200% over ideal weight. I knew that I was borderline with the 100 lb overweight requirement, but I jumped into it anyway. Took the test, was poked and prodded in every orifice of my body. Went to meetings and researched and read everything I could get my hands on. Once my surgeons office submitted the paperwork, I felt pretty sure that I would get approved. I was just a few pounds under. Then I get the big fat DENIAL..and the letter stating that I meet the comorbidities, but am 6.5 UNDER their requirement! So, I have eaten everything I can get my hands on! I feel bloated, greasy and FAT...so I went in today and reweighed...and weighed 6.6 lbs OVER their number! YES!! Here I go again...the waiting...the checking the Tricare site every hour. My new diet and lifestyle starts today, with or without the band. I pray that I get approved and can get banded soon. Would love to get off of blood pressure meds and off of that darn CPAP machine! Will it be just another diet, or will I get on the bandwagon? :party:

Palin! Palin! Palin! I was soooo excited to see McCain pick her. And the fact that her son is going to Iraq on Sept 11th! I am impressed!

I am re-weighing today. My surgeons office will then contact tricare and see if the info needs to be resubmitted or if I need to appeal the denial. I am 6.5 lbs heavier, as Tricare said I needed to be. Wish me luck!

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Thanks! I was looking for that feature!

There are also cardiovascular risks that you need to discuss with your doctor. You need to be aware of ALL of the risks with a hysterectomy. I am not saying NOT to have it done. I just like for all of my patients to be aware of all of the risks and benefits of a surgery and then they can make the best educated decision the is right for the individual. My doctor and I discussed it when I was 30 and we thought that it would be best to wait as long as I could. I continued to get ultrasounds every few months for 10 years until I finally said "enough is enough". Like I said, I have never felt better sinice I had everything removed.

Well, Joy's bmi is 36.2 and she has comorbidities. I am around the same BMI and have several comorbidities too. My surgeon, my family doctor, my obgyn, my psy doc, and my pulmonologist all think I am a great candidate for lapband surgery. I am thankful I did not walk into Froggi's surgeon's office. I am done with this thread.

Why would your surgeon do that! Her BMI is over 35 and she has comorbidities. Most insurance companies will even cover that!

I was 40 years old with severe endometriosis, multiple large ovarian cysts, history of ovarian tumor, painful heavy periods, and a history of miscarriages when I had my total abdominal hysterectomy. I can say that I have never felt better. The endometriosis was growing on my kidneys and causing infections. You are so young that you and your doctor should look into all of the alternatives before making that decision. But I was your age when I started having problems. I took off for 6 weeks and I am on an estrogen patch (vivelle dot). Like I said, I have never felt better in my life (although I am fatter). Good luck!

I think what is upsetting people is the tone of the survey, instead of a simple discussion. The choices "No, it's a waste of money and not worth it", and "No freaking way!!! Just eat a little less dangit!!!" and the fact that as of this time, 24 people have chosen these answers. It makes those of use that have lower BMI's feel as though we need to defend ourselves, and those that are voting that we "don't need it" are being judgmental.We Low BMIers often have to defend ourselves to skinny family and friends that think we should just get off of our A$$es and work out. We shouldn't have to defend ourselves or be judged by our fellow bandsters.

http://seattlepi.nwsource.com/national/180580_bypass03.html

Congrats!! When is your surgery?

I wonder why they didn't give you a potassium run before the procedure? Anyway, good luck to you!

Sue, How does that Tryke do on hills? It looks like fun, but the swerving back and forth could be dangerous in traffic.

We will pray that it lands on the right desk!

I have not heard about any. I am working on an appeal letter, and going to weigh in sometime this week. I need to gain 1 more pound.:smile2:.

There are lots of tricare threads. You can type in "tricare" in the labband search window and they should pop up. Some people have had good experiences, others are jumping through hoops. Good luck!

Tuger, Tricare, in the denial letter, gave me a weight amount that I needed to weigh to be approved. It was the low end of the med build. For instance, I should weigh 227 lbs for 5'5 ht. I weigh 220.5. I fit in the small frame (no doctor stated what frame size I was so I guess they went by the medium frame). They stated that I needed to weigh 227 lbs.

Amanda, if you don't mind me asking, were you under the requirement even by one pound? or did you fall within the range? I am working on gaining the 6.5 lbs, but I want to make sure that is enough. If I fall in range and they deny me, I will go through obesity law.

I was 220.5 at 5'5 with high blood pressure and obstructive sleep apnea (on cpap)

Tricre uses the Met life scale and uses the figures for medium frame. And if you are 6 lbs under...well, you will get denied.

I am on Twitter! NurseJamie is my screen name.

There are plenty of Tricare threads on here. You can search and read our trials and tribulations dealing with them. If you qualify with no questions asked, it is fast and great. I got denied for being 6.5 lbs under with 2 comorbids. I am appealing.

Obesity surgery: Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES) JournalSurgical Endoscopy PublisherSpringer New York ISSN0930-2794 (Print) 1432-2218 (Online) IssueVolume 19, Number 2 / February, 2005 CategoryE.A.E.S. Guidelines DOI10.1007/s00464-004-9194-1 Pages200-221 Subject CollectionMedicine SpringerLink DateMonday, December 06, 2004 S. Sauerland1, 2, L. Angrisani3, M. Belachew4, J. M. Chevallier5, F. Favretti6, N. Finer7, A. Fingerhut8, M. Garcia Caballero9, J. A. Guisado Macias10, R. Mittermair11, M. Morino12, S. Msika13, F. Rubino14, R. Tacchino15, R. Weiner16 and E. A. M. Neugebauer1, 2 Received: 1 August 2004 Accepted: 19 August 2004 Published online: 2 December 2004 AbstractBackground The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectivness and surrounding circumstances of the various types of obesity surgery. Methods A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. Recommendations After the patients multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life. Presented at the 12th International Congress of the European Association for Endoscopic Surgery (E.A.E.S.), Barcelona, Spain, 9-12 June 2004

Cost-Effectiveness and Budget Impact of Obesity Surgery in Patients With Type-2 Diabetes in Three European Countries JournalObesity Surgery PublisherSpringer New York ISSN0960-8923 (Print) 1708-0428 (Online) IssueVolume 16, Number 11 / November, 2006 DOI10.1381/096089206778870067 Pages1488-1503 Subject CollectionMedicine SpringerLink DateTuesday, June 26, 2007 Add to marked items Add to shopping cart Add to saved items Permissions & Reprints Recommend this article Roger Ackroyd1, Jean Mouiel2, Jean-Marc Chevallier3 and Frederic Daoud4 (1) Royal Hallamshire Hospital, General Surgery, Sheffield, South Yorkshire, United Kingdom (2) University of Nice, Obesity Center, Nice, France (3) Hôpital Européen Georges-Pompidou, General Digestive Surgery, Paris, France (4) Medalliance, Paris, France Published online: 01 November 2006 Background: We aimed to establish a payer-perspective cost-effectiveness and budget impact (BI) model of adjustable gastric banding (AGB) and gastric bypass (GBP) vs conventional treatment (CT) in patients with BMI ≥35 kg/m2 and type-2 diabetes T2DM, in Germany, UK and France. Methods: Clinical evidence was obtained from literature and patient-reported EQ-5D scores given BMI and T2DM status from HODaR. Resource utilization data in AGB, GBP and CT were obtained from quoted publications so as to reflect practice in 2005. CT in each country was based on descriptions in HTA reports or based on co-authors' experience of current practice. Unit costs were obtained from published sources when available, or from co-authors' institutions. A deterministic algorithm with cost and utility discounting, enabled selection of inputs independently throughout the time scope for each of the 3 treatments, and included mean BMI, amounts of resources and unit costs. Results: The base case time-scope was 5 years, and the annual discount rate for utilities and costs was 3.5%. Compared to CT, GBP yielded +80.8 kg/m2.years, +2.6 T2DM-free-years and +1.34 QALYs. AGB yielded +57.8 kg/m2.years, +2.5 T2DM-free-years and +1.03 QALYs. In Germany and France, both GBP and AGB yielded a cost decrease, and were thus dominant in terms of ICER compared to CT. In the UK, GBP and AGB yielded a cost increase, but were cost-effective. Conclusion: In patients with T2DM and BMI ≥35 kg/m2, AGB and GBP are effective at 5-year follow-up in cost-saving in Germany and France, and are cost-effective in the UK with a moderate BI vs CT.