sunnylilme

Was Fedorak band-friendly? Did he try to push bypass? I'm not sure if I want to go with Fedorak or Fisher. I'm so tired of docs trying to push bypass on me!!

Hey, I'd love to talk to you about Dr. Russi. Drop me a line..

I'm getting banded by Dr. Russi I think. I go for my first appt on Wednesday. I've been trying to get banded since June, with no luck. Hopefully since we PCS'd, it will be easier!

awww...maggie. I'm in the same boat. i am 260, 5'6. I have sleep apnea, and I'm on the CPAP. I got denied. I think maybe my doc's office didn't include all my sleep test stuff, maybe. I think it's my doc. Don't give up. Lots and lots of people get approved after a denial. You can call, and they will give you a reason for the denial, even though the reason isn't in your letter. THey told me that depression was my only comorbidity, and it doesn't count....so they just didn't get my sleep apnea info... Keep trying, I am!

PS...there was also a cockroach!!! in the nutritionist's office...ick..

Hi there.. I'm having troubles...I need to vent. I went to Dr. Mailapur's seminar, and he really, really loves gastric bypass. He doesn't believe the band is effective. In fact, He didn't even do the band until fairly recently. Regardless, I made an appointment with him, because I've heard he is an excellent surgeon. I just couldn't in good conscience go to him though, because he didn't believe in "my dream". I've heard without a doc familiar in fills, you can fail, and I just can't fail this....again. He only charge that Tricare didn't cover was a $175 office visit. Dr. Mailapur had an insurance specialist speak at his seminar for maybe 20 mins on what each insurance company requires. Mine requires 100 lbs over ideal weight with one co-morbidity, or 200% over ideal weight with no comorbidities. So, the only other person Tricare covered was Dr. Foreman. So I went to him. He has 600-800 dollars worth of things my insurance won't cover, and I have excellent insurance. I decided to pay these things in good faith, and figured in the long run, it would help me. I think it was $200 for his insurance specialist and "metobolism testing", $200 dollars for body fat analysis, $200 dollars for an office visit. There are other things after the surgery, but this is what I have had thus far. So I've done all of this, and paid all of these things. I saw Dr. Foreman, and asked if I qualify, and he said he could have no way of knowing this. He has only had one Tricare patient prior to me. I asked if a sleep study would help, if I needed a comorbidity, he said, it couldn't hurt. He just submits the paperwork, and I get approved or denied. He also much prefers bypass, btw. So...I did the sleep study, got the comorbidity of sleep apnea, got the cpap. I called his "insurance specialist" to see if sleep apnea was a comorbidity, if I was 100 lbs over, or 200%. She has no clue. I have left her so many messages, I can not get a call back, so finally I went in and requested her. I had printed out Tricare's policy, and the metlife scales that they use. She said "thanks" I'll take this, I need to know this. So they submitted the paperwork, I was DENIED. I know I qualify according to Tricare's standard. Forman's office is just so stupid on insurance matters. They don't know why I was denied, or what I need to do or change....nothing. So, because I felt I qualify, they sent an appeal, with I think the same information. Tricare says that it's all on the doc, and the doc knows why I was denied. This has been going on since June. I'm starting to get so discouraged.

Do you have a comorbidity?

Why did you get denied the first time? Was the appeal any different than the original request? I checked mine wayyyy too often online:) Best of luck!!

You're talking to me on two threads, yes:) So you had to have all of these prior to submitting your packet?

Yes, this is the first time I was denied. I don't think I need to gain weight, because I am 5'6 253. I think they didn't get my sleep apnea thing in time.. I'm getting lapband, and Tricare is paying for it:)

Did you have to have psych eval, ekg, bloodwork, before the approval or after?

Do I need the psych eval, bloodwork, ekg...all of that before I try to get approved by tricare?

My doc doesn't seem to know ANYTHING about Tricare. He's only ever had one Tricare patient before. I asked him if I qualified, or if I needed a co-morbidity, he said he didn't know. He would hold my paperwork until I wanted them to submit. I think maybe Tricare didn't get my sleep apnea info fast enough, or maybe I have to have my second sleep study with the cpap before I have that particular co-morbidity? The doc hasn't asked me to get a psych eval, I figured I had to do that after I got approved. I thought I was going to be a Sept Samuri. I've been having dreams at night about the new me:((

I'm on it. I hope an appeal isn't much harder than the first process.

Okay...I am 5'6 253. I got denied. I had my sleep test, and I have moderate sleep apnea, and they want me to go back for a cpap to get fitted for the sleep mask thingie. Is sleep apnea a comorbidity. Is it 100 lbs over ideal weight with 1 comorbidity? I am so, so upset. I'm worried I'll be this huge for the rest of my life:(