KarinaM

DO I need to tell you how HAPPY I am for you????? CONGRASTS!!!!!!You deserve it.

Well here it is: I gained 30lb (did not reach the 100lb over by THEIR scale table), I also ate chocolate before my fasting blood test so my blod suar went up 103 and I shrunk 2 inches. I still got denied because of the 100lb. I guess I need to get some ankle weights???? Good luck.

Got my letter from Tricare. Did not answer any of my questions. This is what it says: Based on the review of the request for authorization, our physitian reviewers have denied the request. Tricare will not pay for these services because they are not covered according to the TRICARE Policy Manual. This is a factual determination based on the indication below. Using the current Metropolitan Life Tables <LI class=li_a>The patient is 100 pounds over the ideal weight for height and bone structure and has one of the following associated medical conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints. The patient is 200 percent or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category. I really wonder if they considered me as a diabetic or not. I do now I am 228lb and 5'5 and medium frame so I guess I need at least 10Lb to 15Lb. I'm already looking for ankle weights and waist weights so I can weight in. Any sugestions?????

What it is getting me more mad is the fact I DON"T KNOW WHY I WAS DENIED. They told me I was denied by the Medical DIrector an dI need to wait for my letter on the mail (7 to 10 bus days). I had a very bad day it was like the world had fallen on me. My husband was great and weants me to forget this hole thing and try to change my life habits and start exercise. I wish I could pay for the surgery.... Maggie good luck on your appt tomorrow. Let us know how it was.

I was denied today and I don't know he reason yet. I can't believe it.

Hi, just checked online and it was showing a code: ANC and I called and I was told I was denied and since the letter was not generated I have no idea WHY I was denied. I guess I will see if I can appeal or not.

Are you serious???? Today was a real Soap Opera. You have no idea. I called Tricare, they told me they never got anything. I called Yvette(surgeon coord) and she garantee she had send it. After calling Tricare a few times and trying to contact Yvette again, I left her a message asking her to fax it again and I also told her I could go there and fax it for her, if she needed. She never called me back. At the time my husband got home I was in tears with all this run arround. At the same time Yvette called me telling me she had refaxed Tricare and now she had a confirmation and she had faxed to other fax number. I will call again tomorrow and see whats going on. ONE MORE DAY TO WAIT. Thanks for the support, Maggie.

I will try. When I called the Surgery Coord told me she had send to Tricare everything they needed and when I called Tricare they told me they still needed more clinic info and that the Dr's office had requested a call. I gues this will take way longer then I was expecting. Thanks for all the support.

Why is she telling you you are not gettin approved? Are you way under weight??? They should not tell you that.

Hi, I called Tricare and they told me the surgery coodenator had called tricare and she asked to talk to the nurce in charge, but at least she called. Maybe by monday I will know something. I guess will be a LONG weekend.

Ashley, you will need to work the "system" a little. I went to my PCM and cryed and told her how miserable I was and how much I needed the surgery. I'm not 100lb over but before my blood work, I had some chocollate and my blood sugar went up, after that, I put on a little more pounds and after getting the approval for the surgeon, my PCM also helped me to get a sleep study. I had my PSY eval (tricare will give you 9 seccions with a PSY, just don't tell Tricare is for WLS eval, just do it as a consultation, you will have to let the PSY Dr. know, of course you need a eval for WLS. I also "got shorter" 2" hehehehe, making my BMI higher. I'm not sure if it will work, but since they never want to pay for anything, I think we need to do our part sometimes. Hope this help you and DO NOT GIVE UP.

I called at the end of today and still nothing. I had decided to be there tomorrow at 9am but my husband thinks I will getting her pissed off at me and this will not help me at all. He told me to wait, like it is easy

I'm having the same problem now. I have ALL my stuff ready and it was faxed on friday to Tricare (It could be done on thursday but the surgeon coord did not fax it), on monday I called and they told me they needed some referral form filled out. Yesterday, I called again because was still pending and I was told they need some "clinical info" from the Dr's office, I keep calling the surgeon coord and when I finnaly got hold of her yesterday she telled me she was too busy and had no time to talk to the Tricare nurse. I called today all day and she still have not send the info to Tricare. Apparently the nurse at Tricare wants to know if I am taking medication ofr Diabetes and other info and I'm depending on this lady. Wait is killing me.

I know, I think you were approved by what they told you. I'm also a control freak and I think I am getting everyone insane at Tricare and also at the Dr's office. Can you imagine my family? I just want an anwer and NEED to be the A letter. Let me know as soon as they approve you. I think my surgery in case I get approved will not be until end September because my Dr. is very busy. As long as I get this before October, I'm happy. GOOD LUCK.

Called Tricare again and they told me the Dr's office did not fax the info they need YET. I called the lady and after 10min waiting they told me to leave her a message. If she does not called me with in 3 hous I will be going over there and ask to fax my self. Is this to extreme??????

Maggie, I called Tricare AGAIN this morning and they told me she had no faxed the remainder information to Tricare yet. I called her and I was on hold for over 10min and they told me they would give her my message. I'm seriously thinking on going there and talking to her in person. Is this too much???????

I had my papaerwork submited on friday but they needed a referal form filled out and the Dr.'s office faxed late friday. Yesterday was showing pending online and today I was told they needed more "clinical information" from my Dr. I called the surgeon coord and she told me she had NO TIME and she would send it to Tricare WHEN SHE HAD TIME. In the mean while I'm ready to have a stroke, I check the Tricare online every 5 min, I can do or think about anything else. I wonder if the fact they need more info it is a good or bad thing....

Hi, I had all my stuff together(PCM letter, Psy eval, nutricionist eval,blood test, sleep study and surgeons letter) and the surgeon coordinator at m Dr's office sent everything to Tricare on friday, on monday I called and they told me they needed a refferal form from the Dr's office to be filled out. I called the surgeon coordinator and she told me she would send it. On monday I called and they told me they got the fax and it was pending.Next day I could see online on pending. Called again on wed and they are telling me they need more clinical info from the Dr, called the surgeon coordinator and she told me she had no time to send anything but she would contact Tricare when she had time, so I'm not waiting on Tricare, but on the Dr's office. I hope I get approved.I wonder if the fact they need more info is a good thing or not....

Thank you, I even had a migraine this morning, I think it is tension. I checked Triwest website about 25 times today, the good news was that I was able to see as pending today. I'm so scared I will get denied. Thanks for the support.

Hi I just had all my paperwork submited: PCP letter, sleep study pscy eval nutricionist eval blood test surgeon letter I called tricare today and they received and told me 3-5 business days and the wait is killing me I check the website every 5 min I think I will go crazy. I tryed to get my weight up but my BMI still 38, so I'm very worried about a deniel. I do have high blood sugar but not diabetic really, high cholesterol and accid reflux desease, so I'm hopping to get approved. At first I wanted the lapband but later I decided to go extreme and get the GPS. My husband supports me but he wants me to go and get the band not the GBS, I think he is worried about the surgery and thinks I'm not that fat for something so extreme. Please pray for me.

I understand. I had a friend also with Tricare, her husband is in the USCG with my husband and her husband was completly against the surgery but she did not care and did it anyway. Guess what he loves the results, she looks great and he is very happy now. Keep going do not get discourage.

Hi, I am 5'5 and 223lb, so my BMI is under 40, but with some cheating on blood test I got my sugar level high and also have high cholesterol, so I'm hopping to get my surgery approved, but I am extremly worrid I will be denied, since I am not 100lb over. I already had my PCM letter, nutricionist consultation, psyh evaluation, sleep sutdy done and the surgeon was going to send the request to be approved for surgery last friday. I keep checking the website and there is nothing there. I hope I can get approved.