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dl2418

LAP-BAND Patients
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Posts posted by dl2418


  1. Greetings all,

    So a small victory for me this weekend.....my husband I were at Target and they were stocking the Easter stuff, and the baskets and candy. Well I walked right past the Peeps and did not even grab any for my cart. For me that is such a huge huge victory!!! Peeps are my weekness, I so love those marshmallow confections!!!! Anyway, everyone have a wonderful Wednesday!!

    Monica

    Cadbury eggs are my weakness! That yummy creamy goodness covered in chocolate....yeah, those are the ones!

    None for me this year, no birthday cake or icecream or green beer for me this year either!


  2. #1. Surgery date? Not sure yet....

    #2. State you live in? Kansas

    #3. Doctor/Surgery Center? Dr. Bernsten at Tallgrass

    #4. Insurance or self pay? Tricare

    #5. Age and height 30+ and 5'1"

    #6. Current weight and goal weight? 230/140

    #7. What was your deciding factor for having this surgery? I want to be a better mom, a more active mom, and I'm just plain tired of being fat despite everything I've tried before.

    #7. Do you have the support of family and friends? yes

    #8. Concerns and questions? Finding a decent tasting high Protein Meal Replacement for the liquid phases and getting my whole family to eat better.


  3. I am glad that you are trying to get approved again. I have Tricare Standard and I was approved in less than 48 hours. I am 100lbs overweight and have a MILD form of sleep apnea. If you do not have any qualifying co-morbidities, have you surgeon order a sleep study. The results of the sleep study helped me to qualify for the lap-band®.

    Good luck to you.

    I never had the sleep study done. But I've noticed since my weight gain, I can feel how heavy my chest is and just rolling over in bed can make me breathe heavy. :tongue2:

    I'm hoping for approval but would do the sleep study if it would get me qualified. The arthritis in my knees wasn't bad enough, blood pressure not high enough and I'm not diabetic. So at 100lbs overweigh my co-morbids weren't severe enough. But now I'm closer to being 200% over, so hopefully I won't need the comorbids.


  4. 1.What is your current and goal weight? Current 230/Goal 140 (much below that and I look ill)

    2.What is your surgery date? Not scheduled yet. Resubmitting since I've gained weight.

    3.What is your age? 32

    4.Where do you live? KS

    5.Where are you having surgery? Turning Point Bariatrics

    6.Who is your Doctor?? Dr. Bernsten

    7.Insurance or self-pay? Insurance

    8.What was you "deciding factor" for having this surgery? Dieting and excercise just result in yo-yoing. I have kids and want to be thin and healthy enough to do all the fun things they want to do and deserve to do.


  5. About a year ago I went through the process and was denied because my comorbidities weren't severe enough. So I tried diet, excercise and to at least maintain. However I've gained about 15 pounds which puts me at the low end of being 200% over. Lack of energy, lack of self esteem, joint pain and GERD has of course gotten worse with the weight gain.

    I go in one week from today to reweigh and update H&P and resubmit. I'm currently on prednisolone for an allergic reaction, so hopefully that weight gain will come into play before my appt. Tuesday.

    Wish me luck!


  6. It sounds like you meet their criteria and then some. You do have Prime right? Sounds like the run around to me. I got a surgery date a month after my consultation so hopefully the process will be smooth for you this time around!! (((((((((((Good Luck))))))))))))

    I was Prime. But due to issues with my PCM and difficulty with access to appointments for the kids, we're now Standard. We pay more but it's so worth it.

    MetLife minimum ideal body weight for my height is 115. I'm at 218, so "borderline" on the 100#. I think that's why they want the x-ray reports and not just the letters, office notes from my doctors. *sigh* Morbid obesity runs in my family and while I can't blame it all on genetics, two have already had gastric bypass and I'm trying to get it under control while I can....


  7. So we submitted again and Tricare wanted radiological reports of arthritis. I am 100# overweight by the MetLife table for medium frame. I've been treated with Enbrel for psoriatic arthritis, have GERD, benign hypertension and thankfully radiological evidence of mild osteoarthritis. Letters from two doctors recommending Lap-band as the way to deal with these issues.

    My husband is coming home from Iraq in a few months and I don't want to have to gain 10# just to meet the 200% overweight criteria.

    Vibes I get approved please.


  8. So about a week ago I got the call saying Tricare wanted more info. Well I couldn't get into my PCM until Wed. I got a letter from Tricare today saying that my banding was not approved. (by the way there's still nothing on the triwest site, I've been looking since it was submitted).

    So, can anyone give me advice on how to appeal? They wanted a letter from my PCM stating that the joint pain from arthritis was interfering with ADL's or X-rays showing arthritis. However my PCM didn't want to do the X-rays because even with arthritis the X ray may not show abnormal and he agreed to write the letter. Should I get records from my dermatologist who prescribed me Enbrel for my psoriasis (which can cause arthritis) as well as the letter from my PCM?

    Any advice on how to go about this and get it approved would be greatly appreciated. Has anyone had it denied still after appeal?


  9. Why do you say Tricare Prime people have a struggle to get an approval. I am Tricare Prime and my doctors office is getting everything together now for me to get it turned into Tricare this coming week. Where do you go online to check on it?

    I am Tricare Prime and my biggest hurdle so far was getting the prior auth from my PCM to get my psych eval done. Once my surgeon got that, they submitted and I got a phone call a few days later stating that Tricare wanted more information. Either X-rays showing arthritis or a letter from my PCM or ortho that the joint pain was interfering with activities of daily living. I had an appt. yesterday with my PCM and he said he'd submit a letter because X-rays may not show any abnormalities. Hopefully it will be enough to get the approval as well as the GERD. We'll see.....I weighed 220 so I met the 100# overweight for my height.


  10. I am Tricare Prime and am going through the process at the moment. My biggest hurdle was getting my PCM to get the prior authorization for my psych eval. Seriously! Once they finally got to it, it took less than 48 hours to get it! :tongue2:

    I am in the Triwest region. I had to get the referral to the surgeon from my PCM. My surgeon requires the free seminar. Once I attended that and sent back the paperwork they gave at the seminar, I was able to schedule my initial consult. It was postponed twice because of things on their end. I met with the surgeon, finally got my psych eval and it should be at Tricare now....just waiting to hear if it was approved.

    I am 5'1" and weighed in at 220. I have GERD and my blood pressure is borderline at this point. We will see what Tricare says. **keeping my fingers crossed**

    The nurse at my surgeon's office that handles all the insurance stuff says Tricare is the least predictable and every time she thinks she has them figured out, they do something to surprise her.

PatchAid Vitamin Patches

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