lisw55

Hi Kristy, You may have already been to Japan and returned, but I just wanted to let you and anyone else who may be flying to Japan know about Dr. Kazama and Dr. Seki from the Yotsuya Medical Cube which is a small private hospital located in Tokyo. You can Google the hospital and get the telephone number. Ask for the doctors and they will make sure that you get an appointment. Will you be visiting or will you be living in Japan? Chances are if you are visiting you will not have any problems during your visit. I was on mushies when I flew to Japan 2 weeks after my surgery. The Airlines allowed me to bring small bottles of baby food (meat) due to my dietary restrictions. Actually, they were quite accommodating. Hopefully, you had a great time in Japan!! Leona

Minksymom, I will find my letter scan and send it to you. Some kind soul sent me a copy of their letter, so I had a general idea of what I needed to address in the letter. It was an appeal letter and took 15 days for approval. I called to check on the progress and could not believe the guy when he said it had been approved. I asked if he would check it again to make sure the approval was under my name. He just laughed and told me to trust him that it had been approved. Then I was nuts for 3 weeks until I got the letter in the mail. By that time I had the surgery scheduled and was ready to go for it! It may take me a few days to find the letter and scan and send it. I'll need you email. Leona

Dear FissyLove, I was initially turned down with a BMI of 39 and co morbiditiies. Then I spent the next 6 weeks feeling sorry for myself. Do your self a favor by skipping this part and sit down wth all the facts to write a rebuttal letter to the insurance company that includes everyting you have done to get ready for the surgery to include hard facts regarding how much money they have already spent on your care and how much they could potentially spend on you over the next 20 years for your care if you do not have the surgery. Writing this letter took one week and was the most important step in my journey. I had just lost my youngest sister to heart failure that began due to morbid obesity. The insurance company was not going to take charge of my life. Instead I took charge and am now a healthy person. Stand up and take charge and do not let these bullies keep you from being healthy. IMO, you do not need a lawyer until all your options have been exhausted. God Bless you!! Now go out there and get your lapband surgery approved!! Leona

Many military treatment facilities do not have a surgeon that is credentialed to provide follow-up care that is needed after LB surgery.

Drhodes, Do you live near a military installation? If so, you could contact the Drug and Alcohol Program. I believe they would be more than willing to write up a statement for Tricare to indicate you are not an abuser. They may want to do a brief assessment, but having worked with these folks for many years they might enjoy helping you. It's just a thought. Take care

Hello, With a BMI of 38.6/218, you only need to gain 12-15 pounds. If you are set to have the LB that is the easiest and fastest way to solve your problem. Have you been tested for sleep apnea? If not have your PCM refer you for testing. Just my 2 cents. Try not to be so frustrated by the insensitivity of Tricare, but at the same time you may need to go above and beyond what others have had to do to get the approval. This is based on myown personal experience. Take care and bee good to yourself.

Hello Thinner, I'd like to suggest that you request the specific requirements for WLS in writing from UHC. It may take a while to accomplish this goal of getting the requirements in writing, but I can guarantee it will be well worth your time and energy in the end. This was a key document for my appeal process. Good luck and take care!

I agree with Restless 100%. Be honest and tell them what you think, it will be okay.

Hello Tauns, I would like to welcome you and hope that you learn whatever you need to know from this forum. I'd like to suggest that you contact your insurance company to request the specific policy requirements in writing. This may take multiple calls to get, but please protect yourself up front. I know just how important that step is from personal experience. Next choose a surgeon that requires a comprehensive approach to the lapband qualification process. Nutrition classes, nurse case management, behavioralist, support groups, and exercise. There is so much to learn that will support your success. Take the time to learn from others. Also, your question about telling others. Each person you tell has a different opinion about WLS, so I might suggest that you take it slow and only talk to others if they have a need to know until you are confident that WLS right for you. Take care and Be good to yourself along the way. Seeking WLS can be an emotional journey. :rolleyes2:

I should be in the 136-150 range, so at 248 it is a close call. I have been working on this since last August. My PCM and surgeon are ready to go, but my primary insurance decided to exclude 35+ with comorbilities as of 1 Jan 09. I faxed my appeal to UHC yesterday, which I believe will be denied so am thinking plan B is Tricare or plan C to change to another company in Nov during Open Season. It's so hard for me to believe that my employer (US Army) would exclude wls when they are generally very supportive of the health and wellness of thier civilian workforce. I promised myself there would be no more whining, so I better get a grip and think positively!! Thanks for the direction with the chart.

I wonder what scale/chart that Tricare uses to determine if you are 100 pounds over weight?

Hi Karina, I am just wondering what you think about my situation. I have Tricare standard and am wondering if you think they may approve a BMI of 37.4 with Sleep apnea, hypertension, high cholesterol, and hypothyroidism?

I would like to talk with you offline regarding Tricare Standard coverage. My email is lisw50@yahoo.com Thanks Leona

I began this journey in August 08. In Sept after many calls to the insurance company they provided me with a letter stating what the requirements were for WLS. 40 BMI or 35 plus comorbities. My BMI was 37.4 in addition to the following diagnoses: sleep Apnea, hypertension, high cholesterol, and hypothyroidism. I completed all requirements, returned to my surgeon 15 Jan 09 and was denied on 22 Jan due to the change in the policy as of 1 Jan. Today, is the first day I have been able to think about the situation since the denial. Do you think I have a chance with an appeal? Thanks for any information. Leona

I am so happy to hear you have been approved!! I would like to speak with you offline regarding your Primary and Secondary insurances. My email is lisw50@yahoo.com Thanks so much!

I am considering a position in Japan, but must locate a Dr. for fills before I will even consider making the move. Do you know of any Dr's that might provide fills? Any information is greatly appreciated! Arrigato!

Regarding UHC, does anyone have the APWU UHC Consumer Driven coverage? If so, can you tell me how to get a copy of the requirements? Is there a weblink that I can tap into to find the specifics. Thanks

BKLYN1984, Once again "thank you" so much! It's beginning to make sense and I am feeling better. Hopefully we will meet at the support group meeting. Take care. Leona

BKLYN1984, Thank you for your response. Dr. Kipnis requires that his patients participate in this program. I was just a bit irritated because someone at his office told me he did not require the program. So, I spent many hours locating similar services (free) on Fort Dix and McGuire to be told I had wasted my time. I understand where he is coming from in that he does not know the registered dietician, exercise physiologist, or personal trainer that I had lined up. So, I will go forward and join the program like it or not. I guess to help myself justify the cost of the New Beginnings program, I will plan to use the base resources for follow up care. See now, I am feeling better about the whole thing. Does the behavioral therapist just use interviews or a combo of interview and personality testing to accomplish the psych eval? Do you know his/her qualifications? Have you attended the support groups? If so, were they helpful? Also, do the cae managers talk about their success rate with the insurance companies? I am just full of so many questions. This is my last hope. I want to retire sometime in the next 10 years, but I do not want to retire because of my health. Many years ago, I worked on a physical rehabilitation unit and each day I would interview new patients that would tell me their stories about how they had been waiting to retire so they could travel or do other exciting things. Unfortunately, for many of them they experienced life changing health problems such as stroke, heart disease, diabetes, etc. and their dreams were taken away. My goal is to stop this from happening. I am commited to the process. Thanks for listening and know that I appreciate any information. I hope you have a wonderful day! Leona

I guess I just want to know if the program is worth $1,950. This is a lot of money for me to spend on top of the time and cost of gas to drive to Voorhees. So, I just want to make sure I am spending the money on a good program. Thanks for any information you may have.

Hello All, I am wondering if anyone has worked with this program. Also, has anyone out their worked with Seth Kipnis from Cherry Hill? If so, I would love to talk to you. Thanks Leona

Hi bklyn1984, I am wondering who your surgeon is? I am looking for a surgeon in Burlington County. I know it does not help, but try to keep your chin up it sounds like it will just be a matter of time before all the paperwork gets straightened out. Take Care! Lisw55

Hi Carly, I am just beginning the process. My primary insurance is with United Health Care with Tricare Standard as the secondary. I've been to an informational meeting, asked for a referral from my PCP, and scheduled an initial appointment with a local surgeon. I guess my question is did you have any problems with Tricare? Leona