hope2bthinr

I'll try for 15lbs. I have a trip to Puerto Rico in August and need to get back on the losing track after plateauing for 6 months. CAN YOU SPELL FRUSTRATED?? It's my fault, hard to stay on food plan when traveling, hard to stay on exercise plan when workout partner has an excuse not to every other day. Of course both issues are within my control, and they are just excuses.... Saw my surgeon for an adjustment, so now it's time to get seriously serious!!

Yes, I think I paid the hospital about $84.00. Their bill was $43,000 but allowed amount was about $7600. It was the copays of all the different billers that added up to the total. I never met my catastrophic cap so it wasn't that that limited the amount I owed. That's why its difficult to find a dr. that takes Tricare. But they are out there. The allowed amount is low, but the cost to the insured...you can't beat it!! I had private secondary ins at the time, more trouble than it was worth, it paid zero. Now I have a cheap supplemental plan that will pay the difference if I need to have any thing going forward, or complications. You might want to check on one before seeking the surgery if you aren't too far into it yet or maybe for afterward in case of complications. Don't think that's likely, but I'm one of those people that likes to be prepared for anything! LOL!! Good luck to you!!

Hi, I was afraid I'd end up paying a lot out of pocket after seeing the hospital bill. I ended up about $800 out of pocket for the actual surgery, doc fee, pre-op blood tests n xray, anesthesiologist and dr assistant. I had Tricare Standard in the western region managed by TriWest Health Alliance. Hope that helps.

I agree with you there's nothing to feel ashamed of but you can try to keep yourself healthy and fit...there's nothing wrong in it...And I would suggest to try natural way to keep yourself fit there are many online help that you can take like this site Easy Natural Weight Loss...

This person's profile looks to me like they are only here to advertize another weightloss GIMMICK. NO THANKS!! TAKE IT SOMEWHERE ELSE!

Well, I do agree that the gasX strips didn't help with the body gas, but I didn't have much of that, luckily. I DID have quite a bit of the other kind after drinking my Protein drinks for the first 6 days or so until my body got used to them. I think blending a Protein Drink in a blender puts air into it. Or my body just had to get used to no solids and get over it. LOL!! Anyway, I had a lot of THAT type of gas and the gasX did help it.

I had surgery the 19th and I'm feeling great. Been back to work for a week already.

I was banded monday and home tuesday. I've been putting ice packs around the uncomfortable port site and I have to say it has helped tremendously. I'm without pain meds all day today. But everyone is different, so try different things. I also walked at least every hour for about 5-10 minutes and took gasX strips. All of this I read on this site in various threads. You might try doing some searches for what people did to deal with the pain and make it decrease faster. I slept in a recliner the first three nights, not expecting the flat bed to be comfortable till the pain in the incisions was better tolerated.

Hope this helps. Hang in there. It gets better every day.

I am in the Tucson AZ area and went to Dr. Sarah J Lee in Oro Valley. The process, although it seemed long, was straight forward and just took time to complete and deal with insurance snags. The office called me the day I got home and made clear I should call their office if I had any concerns or questions. Dr. Lee is available 24 hours if an emergency arises. Dr. Lee is easy to talk to and provides tons of information to make sure the patient is informed of the process, the procedure, after care, possible complications, preventing complications (to the extent possible by following the recommendations and requirements) support group meetings, etc. Best of all, I didn't feel like another surgery in the assembly line.

I just wanted to give a shout out for Dr. Lee!! Thanks to Dr. Lee and her wonderful staff!!

and adding myself back in for the third try....

Happyloser 10/1

heyred1 10/1

bethany329 10/1

Timmers 10/1

Lindac80 10/1

Marfar7 10/1

Ca7696 10/2

Opus03 10/2

RedboneLA 10/3

ihavehope3 10/3

Viking_girl 10/5

leetie 10/7

Jtreece 10/8

MommyOf1 10/8

Suz-Q 10/9

Noodles 10/9

SharPei 10/13

Guy 10/13

Cshytle 10/13

MoniqueD 10/14

Jenfromtheburg 10/14

ncarreras 10/14

angela677 10/15

Kme 10/15

Nooshie 10/15

munkee'smommy 10/15

Oliverdog 10/16

danyett 10/16

We3601 10/19

Onikenbai 10/19

Thegerm 10/19

Chickychoo 10/19

hope2bthinr 10/19

kcg 10/20

Mzcancer 10/20

Soexcited 10/21

erenstar983 10/21

pina3940 10/21

jenrobbar951 TBA

HDmama 10/22

Cindylou00 10/23

Crazychica133 10/26

Idahlem72 10/27

Daria77 10/27

Barley 10/28

4girlfamily 10/29

Tina 10/29

That's fantastic!! You will be fine. Just remember all the things you did right!!!

I was approved after appealing. Luckily the appeal only took ten days from the day I called the surgeon and got re-eveluated. turns out I was under weight the first "official" weigh in but was over the threshold the second time when re-evaluated. I'm scheduled for next monday!! Oct. 19th! Can't wait!! All my preop testing is complete and I'm cleared for the surgery. Yeay! I'm so happy!! (jumping up and down inside daily until then!)

Oh yeah, brat7169, Tricare Standard does not have a six month or three month or any other supervised diet before clearing you. Either you're authorized or not. It sounds like your Dr may be going by his own requirements or confusing some other insurance with Tricare. Hope this helps.

I'm just posting the list again since somehow I got left off after putting my name and date on.

"Hello Everyone...if your name is not here why dont you copy and paste then add your name and date!

Happyloser 10/1

bethany329 10/1

Timmers 10/1

Lindac80 10/1

Marfar7 10/1

Ca7696 10/2

Opus03 10/2

RedboneLA 10/3

ihavehope3 10/3

Viking_girl 10/5

leetie 10/7

Jtreece 10/8

MommyOf1 10/8

Suz-Q 10/9

Noodles 10/9

SharPei 10/13

Guy 10/13

Cshytle 10/13

MoniqueD 10/14

Jenfromtheburg 10/14

ncarreras 10/14

angela677 10/15

Kme 10/15

Nooshie 10/15

munkee'smommy 10/15

Oliverdog 10/16

danyett 10/16

We3601 10/19

Onikenbai 10/19

hope2bthinr 10/19

Mzcancer 10/20

Soexcited 10/21

erenstar983 10/21

pina3940 10/21

jenrobbar951 TBA

HDmama 10/22

Crazychica133 10/26

Idahlem72 10/27

Daria77 10/27

Barley 10/28

4girlfamily 10/29

Tina 10/29"

Good Luck to all the October peeps!!

Congrats and good luck!! Hope everything goes well and your recovery is smooth. AND post op diet goes by fast!! LOL!!

Happyloser 10/1

bethany329 10/1

Timmers 10/1

Lindac80 10/1

Marfar7 10/1

Ca7696 10/2

Opus03 10/2

RedboneLA 10/3

ihavehope3 10/3

Viking_girl 10/5

O-2BTHIN 10/07/2009

leetie 10/7

Jtreece 10/8

MommyOf1 10/8

Suz-Q 10/9

Noodles 10/9

SharPei 10/13

Guy 10/13

Cshytle 10/13

MoniqueD 10/14

Jenfromtheburg 10/14

ncarreras 10/14

questions09 10/14

Kme 10/15

Nooshie 10/15 aka Anush/F/50/Sunland, CA/Dr. Quilici

Oliverdog 10/16

danyett 10/16

MeMe* 10/16

We3601 10/19

Onikenbai 10/19

hope2bthinr 10/19 woot!!

1019Joanne 10/19

Mzcancer 10/20

Holly143831 10/20 aka Holly/F/23/Brockton ma/Dr Adam Glasgow

Soexcited 10/21 AKA Patricia/F/44/San Diego, CA/Dr. Horgan U.C.S.D

erenstar983 10/21

pina3940 10/21

jenrobbar951 TBA

HDmama 10/22

Crazychica133 10/26

Idahlem72 10/27

Daria77 10/27

Barley 10/28

4girlfamily 10/29

I hope this worked!! Hi Y'all!! We're finally here, doing it!!! YAY us!!! Good luck everyone!

i was banded october 6th of 2008...i have lost over 140 pounds...i am not going to weight myself till my 1 year bandiversary...i wish u all luck and lots of healthy...fit...happy...thin...success!!!!!!!!!!

Ok, just because I'm curious and in awe...please tell us what your 1 yr anniversary weigh-in results are??? (wild clapping in the background....drumroll.............) and HAPPY BANDIVERSARY!!!

I'm the 19th!! Woot!! Woot!!

I was approved after being denied the first try. I wrote an appeal letter giving additional details on how my weight affects my life and limits my activities. I double checked the information sent in by my Dr, and made sure info was included from my chiropractor saying how many times I had seen them for back pain (I don't take a lot of pain meds since I prefer to try to fix the problem instead of only dealing with the symptoms). In the letter, if you write one, make sure you state your stats, ht, wt, bone structure, and include the metlife ht wt chart for ideal wt with your ideal wt circled. I even calculated 200% of the high end and put it on the paper. Make sure it sounds like you have been well informed as to what the requirements are, what the procedure is all about, what the risks are, etc. My appeal took about 10 days to finally get approved for authorization. With your stats I can't help thinking that either there's a mistake or your age is keeping you from qualifying. Tricare seems to be pretty rigid on their guidelines.

I almost forgot, read your denial letter and find out what it is they are denying you for and that should point you at what has to be addressed/corrected, etc. Details, details, details!!!

Keep trying and don't give up!!!

Good luck!!

My "Band Birthday" is October 19th. WOOHOO!!! I am so excited!!! After trying to get here for 6 months, I'm really, really, really ready....LIKE YESTERDAY. I've been reading the good, the bad and the ugly for that long and still think it is worth it, so here I go!!

Here's wishing everyone here will be "big fat losers"!!! (in a good way of course )

OMG!!! I AM FINALLY APPROVED!!! I am so excited!! I can't even believe it!! It's been five months from my consult with the surgeon.

I'm still waiting after re-eval and resubmit to tricare. FINGERS CROSSED!!!

Yup, what MILWIF said! That's how it was explained to me. So I went on a "weight control" strategy....

Figure out double the high side of your ideal weight range...that's what you need to be to qualify UNLESS you have High blood pressure or one of the other conditions.

If you have one of those conditions THEN you would have to be 100lbs over your high side ideal weight.

I don't know why they can't just use BMI like the rest of ins companies!!

Anyway, good luck on meeting that weight requirement!! Maybe you can still get there.

babyka16, I was just turned down for the same reason. So this is how they figure 200% of your ideal weight... if my ideal weight range on the Metlife tables is 106-118 those two numbers would be 100% of my ideal on the low and high end. So 200% would be double. The new range is 212-236 (for me I would have to weigh over 236). The high one is the one my weight must exceed. I don't know why they even discuss the low end because they only approve you if you are over the high end!! If they would explain it more clearly, they'd have a lot less paper work from people who don't meet the right number.

I went back to my Dr. since it's been 3 months since they weighed me and I now weighed in excess of the amount required so they are resubmitting. I had them add a letter from me personally telling how much my weight affects my life and my family history of diabetes, high blood pressure, heart attacks, heart failure, etc. Even though I don't have them, the evidence is there that as the 8th kid and the only one without those diseases, I will more than likely develop one or more soon. I told how much pain I have when trying to be physically active or just clean house and how depressed I am and embarrassed to go anywhere.

I hoping if there is any doubt, that it will help.

Hope this info helps you know what to do to be successful!!

Just found out this morning that I was denied. CRAP! Now I have to wait for the denial letter before I can do anything. This just sucks.

I WHOLEHEARTEDLY CONCUR!! It just guarantees my deductible will reset before I can get the surgery. My Dr was going to do the procedure 9/29 or 9/30 which would have been just under the wire. At this point I don't even care about the deductible, I'd gladly start over and pay the whole thing if they would just give an approval.

I'm still waiting for the surgeon's office to call and find out what went wrong. :blushing:

Thanks, puts it into perspective, but I meet the 200% of ideal if they looked at it the way it was supposed to be submitted (small frame). Other than that I guess I'm too healthy since I haven't (fortunately) developed all of those obesity related issues (no offense intended, please!). I submitted my family history that shows parents and 7 siblings have heart, obesity, diabetes and high blood pressure, but I guess unless my body actually suffers damage and ends up in that boat, it doesn't matter. I'll be talking to them some more today and will take your suggestion to talk with a supervisor if I don't get it corrected through my surgeon calling.

I would say you're lucky to be approved but I know you'd rather not have the health issues you have that qualify you, or the weight problem. I'm just frustrated. I walk every day even though my feet are killing me and I've tried every diet program under the sun and always gain more than I lost, tried boot camp private trainer and lost 2 lbs after a year and a half of training. And I am trying not to get the health issues.

I wish you the best of success and hope I can join the losers club soon. Thanks for the response and suggestion.

Yippee for you!! Glad yours went so easy. Calling for info isn't the problem, I've made about ten phone calls to them already...getting consistent answers to questions that make the difference between $2000 out of pocket or $25000 out of pocket, is the problem.

I'm going through this stuff with Tricare too. Tricare told my surgeon's office I didn't need pre-auth because I had other insurance and even gave them a authorization #. Then today I called because the website said NOT APPrOVED, but I think someone made a mistake... I'm 5'1", 226lb and small frame, that makes me 200% of my ideal weight between 106-118. My denial said "did not prove medical necessity with the 100lb over + 1 comorb or 200% of ideal wt", that's according to the girl I talked to so I'm thoroughly confused. I think they did not read "small frame" in my file when they reviewed it and I double checked with my surgeon's office to make sure they stated that. Even my primary said I fit small frame. This is such a run around!! Every person you talk to at Tricare gives a different song and dance. One will tell you approved and the next will tell you something completely opposite. I don't even trust that if I get to approval that they will actually pay.

First they said they had to wait for the letter from my primary ins saying whether they'd pay or not, that was a full week when the darn exclusion letter was in the original package of stuff they received. NOW I get to wait some more to either figure out the mistake or file an appeal and wait, and wait, and wait..... any suggestions?

I'm on oxygen at night because of sleep apnea, not the obstructive type, have bad asthma and fall asleep during the day at work daily, back pain, foot pain, stress incontinence, and I feel like I'm strangling by my own fat when I sleep!! I can't believe I have to be heavier to qualify! good grief, I'd never make it through this process all over again. THIS IS SO FRUSTRATING! I'm having the surgeon's office call Tricare in the morning to see what exactly they were looking at and considering when they reviewed it for approval. It's just ridiculous how you can call and get a different answer each time. I don't know what to believe.