hope2bthinr

Ok, so today my PCM saw me as a follow up appointment, and they've had my consult information from the surgeon for a week already and was just reading it while I was sitting there!! So finally they are going to send the letter of medical necessity to the surgeon so the surgeon can request the preauth from insurance. Okay, all well and good, but the surgeon won't request preauth without a Echocardiogram and an EGD WHICH CAN'T GET SCHEDULED ANY EARLIER THAN A MONTH FROM NOW!!! :thumbup: And that's only because of which gastro the PCM decided to refer it to!! :rolleyes2: Now, there are at least 50 other gastros on both my insurances in this town!! Surely it could get scheduled earlier through some other gastro!!! I mean this is the only hold up and I feel like I have been shoving a cart with square wheels up a darn mountain so far and this is just frustrating me to no end. Is it reasonable to request my PC physician refer to a different gastro for the EGD?? :rolleyes2: ....One that can see me sooner so I can finally find out if I'm even going to be approved?? I know other people have spent longer than this going through this process but I've done everything they've asked and more. And this isn't even waiting on insurance or even the surgeon, it's just waiting senselessly for a darn appt. They've never had to ask me for one more piece of info....that's how much I researched and prepared before even going to the surgeon. UUgghh! It's just such a tedious process. Ok, I'm done with my spoiled brat whining... but I am going to call my Dr back and try to see if they'll refer to another gastro. I don't know how I can make a whole month go by without pulling my hair out!! I could have had the Echo done tomorrow but it has to be within 2 wks of surgery, but if the gastro can't do the scope till a month from now, I'd have to get it done all over again. And I don't know why it should take a month to get a stupid appointment. You would think the dr. assistant should have looked for some other one to send me to when I'm only waiting for this to get done with everything I had to do before surgery. Thanks for reading and letting me rant here!!

Ok, so today my PCM saw me as a follow up appointment, and they've had my consult information from the surgeon for a week already and was just reading it while I was sitting there!! So finally they are going to send the letter of medical necessity to the surgeon so the surgeon can request the preauth from insurance. Okay, all well and good, but the surgeon won't request preauth without a Echocardiogram and an EGD WHICH CAN'T GET SCHEDULED ANY EARLIER THAN A MONTH FROM NOW!!! And that's only because of which gastro the PCM decided to refer it to!! :thumbup: Now, there are at least 50 other gastros on both my insurances in this town!! Surely it could get scheduled earlier through some other gastro!!! I mean this is the only hold up and I feel like I have been shoving a cart with square wheels up a darn mountain so far and this is just frustrating me to no end. Is it reasonable to request my PC physician refer to a different gastro for the EGD?? ....One that can see me sooner so I can finally find out if I'm even going to be approved?? I know other people have spent longer than this going through this process but I've done everything they've asked and more. And this isn't even waiting on insurance or even the surgeon, it's just waiting senselessly for a darn appt. They've never had to ask me for one more piece of info....that's how much I researched and prepared before even going to the surgeon. UUgghh! It's just such a tedious process. Ok, I'm done with my spoiled brat whining... but I am going to call my Dr back and try to see if they'll refer to another gastro. I don't know how I can make a whole month go by without pulling my hair out!! I could have had the Echo done tomorrow but it has to be within 2 wks of surgery, but if the gastro can't do the scope till a month from now, I'd have to get it done all over again. And I don't know why it should take a month to get a stupid appointment. You would think the dr. assistant should have looked for some other one to send me to when I'm only waiting for this to get done with everything I had to do before surgery. Thanks for reading and letting me rant here!!

Good Luck!! I'll keep good vibes going your way. I'm going through Tricare too and hoping it all goes smooth. I have Nutrition and Psych Eval tomorrow. I think that's about the last things I have to do. Then hopefully my Dr will submit OR I'll find out what the next hoop is!

That woman must live a sad little life in her head to be so bothered by the fact that you've chosen to lose weight. Lord knows what kind of story she has going on in there!! Be strong and don't let those types get to you. That kind of ignorance isn't worth rewarding with a one minute conversation. You don't have to defend yourself. YOU know the truth.

Thank YOU!! I guess I really didn't understand what they meant by that, the way it's written either. But then, policy manuals...what's perfectly clear to the writer may be perfect mud to the reader!! Thanks so much for posting what you found out. I had downloaded all the pertinent parts of the manual to provide to my doctor's patient coordinator (they hadn't done a preauth for lapband thru TriCare before) because I wanted to make sure they knew what the records need to say perfectly so I don't get a denial. I don't want to delay anything by having to go through the appeals process. Good luck to you!! and to all of us joining the journey.

If you're talking about TriCare, it requires you meet the 100lbs over both the high and the low. Which just seems crazy because obviously if you're 100lbs over the high of that range, you are more than 100lbs for the low end. So why don't they just specify "you need to be 100lbs over the high end of the range for Metlife Height and Weight for the applicable body frame." Anyway, I read the particulars for Tricare which is the only ins. besides maybe Medicare/ medicaid that doesn't go by Body Mass Index. This is copied from the manual... B. In determining the ideal body weight for morbid obesity using the Metropolitan Life Table, contractors must apply 100 pounds (or 200%) to both the lower and higher end of the weight range. Payment will be allowed when beneficiaries meet all requirements for morbid obesity surgery including the ideal weight within the newly determined range.

Wow!!! You look fantastic!! You were beautiful before and even more beautiful after. May I ask how tall you are? And what kind of eating and exercise routine you had?? I'm starting exactly where you did weightwise. Thanks for posting your pictures. They really are inspiration! BTW, I was born in Everett and I come back a couple times a year!

YEAY!! GOOD FOR YOU!!! I hope I can say the same within a few weeks! Way to go!

CONGRATULATIONS!!!

Hey y'all, I'm using Tricare for the first time ever, to try to get LB too. This is very encouraging. I'm not sure yet how far I am from getting the paperwork submitted by my Drs. Can you all shed some light on hoops you had to jump through for Tricare and what weight/comorbs etc you had? I know what their policy says, just wanted to hear some personal experiences. Thanks all. (Sorry for hijacking the thread!!)

If you end up not finding some one up there, try Dr. Sarah J Lee in Oro Valley, north or Tucson. 520-797-3000. Good Luck!! I understand why you'd cut and run.

Good Luck on everything!! I'm going through the same stuff and even though I've had no snags so far, it's a little nerve wracking. I have the beginning of the OMG feeling, still trying not to get too "up" before knowing that the ins co has actually approved me. LOL!!

I am laughing so hard the people next door probably heard me!!! Too, too funny!!!:redface:

Thank you. I still have to see if my Ins will approve so still holding my breath on that part. I didn't have obstructive sleep apnea, (I have the other kind) yet was falling asleep several times a day at work SITTING AT MY DESK (good impression on people walking by, I'm sure!) and never felt rested. I got up in the morning, had coffee and breakfast and then a 15-30 minute nap because I couldn't keep my eyes open. The sleep study said my oxygen levels dropped because I would stop breathing frequently. I never really expected that sleep apnea was the problem, but there ya have it.

Yes, I love that crazy looking cat. Its facial expression is a great representation of my state of mind sometimes. It makes me laugh. I suppose I should find a picture I can stand to look at one of these days and exchange it for the crazy cat!! Just kidding about the warning.... I was surprised I got that shiver!! Hope you get the delayed restriction. But if not, you are still one fill closer to that sweet spot! You go girl!

BG, you should have a "graphic content" warning before that big fat picture of the needle and syringe!! It gave me the willies. Seriously, shivers up my spine and arm hair on end!! LOL!! I'm not afraid of needles, just don't ask me to look at it, especially while it's in use!! Hide that puppy till it's stuck, out and gone, I say!! Yay for your first fill!!! Patience, patience. (Remind me I said that later after I'm banded and I'm whining about no restriction...)

:wink2: I had my consultation with the surgeon today and it went very well. I'm a good candidate, have the qualifying stats & co morbid conditions, I shrunk an inch :w00t: oops! and came out with the weight required to qualify under my insurance (thank you lord, I can quit trying to keep my weight up). Of course I have to wait for the insurance approval, but each step matters. Must get couple addt'l tests by my PCP, then all that's left is the psych and dietician. I feel so focused on this process.....but I'm absolutely sure I need to do this and don't want anything to get in the way. Good thing I have this blog to write in or I'd drive my hubby crazy with the details and my building excitement. I'm very happy with how the appointment went today, I like the surgeon, she was very patient and informative, spent an hour with me and I feel confident she will do a good job. WOOHOO!!! one more step closer. YESSSSS!!

:thumbup: I had my consultation with the surgeon today and it went very well. I'm a good candidate, have the qualifying stats & co morbid conditions, I shrunk an inch oops! and came out with the weight required to qualify under my insurance (thank you lord, I can quit trying to keep my weight up). Of course I have to wait for the insurance approval, but each step matters. Must get couple addt'l tests by my PCP, then all that's left is the psych and dietician. I feel so focused on this process.....but I'm absolutely sure I need to do this and don't want anything to get in the way. Good thing I have this blog to write in or I'd drive my hubby crazy with the details and my building excitement. I'm very happy with how the appointment went today, I like the surgeon, she was very patient and informative, spent an hour with me and I feel confident she will do a good job. WOOHOO!!! one more step closer. YESSSSS!!

I do have a copy of the requirements for my insurance and I'm going to have to apply the same strategic eating/drinking regimen to get right to the edge of qualifying weight, with a BIG BREAKFAST in the morning, lots to drink too. But it's 100 flippin degrees here so I don't think I can get away with heavily layered clothes without being sent for a psych eval for being nuts!! Yes, Tricare goes by 100lbs over ideal wt, + comorbs or 200% of ideal wt with no comorbs. They use actual wt instead of BMI. Like any ins., make the hoops confusing enough and people and their doctors might flub up so they can deny. I read it very carefully so that I could make sure to jump through the right hoop. I've been eating, some out of stress and most because I need to make the wt requirment and I'm just plain tired of eating so much. This surgeon's office said they hadn't had a lot of Tricare patients so weren't totally familiar. So I also provided them with the info list of requirements. Thanks for the good wishes and suggestions. Must go consume mass quantities.... heh, heh, heh! for now.

I love your pictures, AND your story!! My son is 27 and I still feel like I don't want to let him go every time he leaves town....and I miss him...sniff... Those years he was at home went by in the blink of an eye. All those milestones and memories that get stockpiled in our heads. It's understandable to me now when my mom forgets and occasionally tries to "mommy" me like I'm still 12. It's so hard to wrap your head around the fact that they grew up so soon.

:w00t: I'm SOOO excited! Tomorrow is my conultation day!!! I think I'm on the edge of the 100lb overweight mark req. by Tricare, with a couple co-morbs, also required. I'm keeping fingers crossed, toes and everything else crossed. I'm determined this is the tool I need. Two things I'm worried about is whether they will approve the surgeon I was referred to and then, will the office staff submit everything just the way it must be to meet approval by Tricare quickly. If anyone has the magic formula for submitting to Tricare nowadays for smooth approval, please, please, reveal what it is!!? I've sent in all my releases, medical history, weight history for 5 yrs, weight loss attempts history for last 12 years, and I have documented asthma, stress incontinence, sleep apnea, high cholesterol, back/hip pain treated ongoing for 10 years, GERD, family history of heart problems and diabetes, BMI 42. My prelim blood labs are done, sleep test and Md referral. Attended an info session, attended a support session (req. by surgeon). Can anyone tell me if I'm missing anything?? Thanks!!

I'm SOOO excited! Tomorrow is my conultation day!!! I think I'm on the edge of the 100lb overweight mark req. by Tricare, with a couple co-morbs, also required. I'm keeping fingers crossed, toes and everything else crossed. I'm determined this is the tool I need. Two things I'm worried about is whether they will approve the surgeon I was referred to and then, will the office staff submit everything just the way it must be to meet approval by Tricare quickly. If anyone has the magic formula for submitting to Tricare nowadays for smooth approval, please, please, reveal what it is!!? I've sent in all my releases, medical history, weight history for 5 yrs, weight loss attempts history for last 12 years, and I have documented asthma, stress incontinence, sleep apnea, high cholesterol, back/hip pain treated ongoing for 10 years, GERD, family history of heart problems and diabetes, BMI 42. My prelim blood labs are done, sleep test and Md referral. Attended an info session, attended a support session (req. by surgeon). Can anyone tell me if I'm missing anything?? Thanks!!

Today was better. Not eating everything not nailed down. I guess it helped to unload yesterday... In considering this huge step, and wanting to be successful at it, I'm thinking I need to see someone to help me with assertiveness. The emotional eating usually happens as my auto response to feeling taken advantage of and manipulated. I must do something about that aspect of the reason I gained so much weight in order to really kick a** on this journey.

Ok, I just have to vent for a while because I'm eating like there's no tomorrow, and although I KNOW exactly why, that doesn't help. So I'm getting it off my chest. I had a family reunion over the Memorial Day weekend. I loved seeing all of my relatives I haven't seen in years. But here's the kicker...I have a sister who is the drama queen and charity case of the fam off and on for the last 30 years. Because right now she's out of work and didn't have the money, I made sure she had a plane ticket to get to the reunion, for my mom's sake. You would think that would be a good thing...my mom got all of her kids in one place for her 80th birthday wish, great! Well, this sister seems to think everyone is responsible for all the drama in her life but herself. It seemed as if the whole thing was in her mind "the drama queen episode" instead of mom's birthday/reunion. So the drama was ramped up, and long story made short, I got to be the referee and psychologist for the week we visited my mother and family. It got to the point that the ranting, threats, raving and fit throwing hit a peak one of the days we were on this vacation and on the way to visit a cousin, I finally stopped the car and left her off at a Starbucks just so I could go on and have a visit with my cousin without the manipulating drama. ....that day went better from that point on!! I have a lot of siblings and half grew up in one corner of the country and half in another corner. The older ones have this thing they do when they see each other (which I don't get, but whatever) they say, "IT'S ABOUT TIME!!" That's not even funny in my book but I don't let it bother me. Not so with the drama queen. It takes such a small comment to just turn a fine time into a big hairy confrontation. I'm not even kidding. Picture a 50 year old that stomps around, slamming doors, smoking doubletime (because nicotine is so calming dontcha know), ranting and raving, and generally acting like a 5 year old because one little comment set them off. I just have to say, I was never so happy to drop someone off at their house when we got back to our hometown. I imagine I left skid marks!!! I've decided that after all this time of helping financially, listening to all the "woe is me, why does all this crap always happen to me??" for thirty years, I'm done. Unless there is strong medication and a whole bunch of therapy, I will not be going on vacation with my sister again. I realized that there is absolutely nothing that will make her happy. I'm tired of being tromped on when the only thing I've done is try to help. I'm going to try to be a little bit selfish and take care of me going forward. I'm going to try to get my stress eating under control. I guess I've gotten to the weight I'm at by emotional eating. I'm sure I'll be learning some new coping skills....and I still have my fingers crossed that my insurance will approve me for the biggest part of taking care of me!! My surgeon consult is on Tuesday!! It's finally near. So I'm putting the stress behind me. And I'm looking forward to my new beginning.

Ok, I just have to vent for a while because I'm eating like there's no tomorrow, and although I KNOW exactly why, that doesn't help. So I'm getting it off my chest. I had a family reunion over the Memorial Day weekend. I loved seeing all of my relatives I haven't seen in years. But here's the kicker...I have a sister who is the drama queen and charity case of the fam off and on for the last 30 years. Because right now she's out of work and didn't have the money, I made sure she had a plane ticket to get to the reunion, for my mom's sake. You would think that would be a good thing...my mom got all of her kids in one place for her 80th birthday wish, great! Well, this sister seems to think everyone is responsible for all the drama in her life but herself. It seemed as if the whole thing was in her mind "the drama queen episode" instead of mom's birthday/reunion. So the drama was ramped up, and long story made short, I got to be the referee and psychologist for the week we visited my mother and family. It got to the point that the ranting, threats, raving and fit throwing hit a peak one of the days we were on this vacation and on the way to visit a cousin, I finally stopped the car and left her off at a Starbucks just so I could go on and have a visit with my cousin without the manipulating drama. ....that day went better from that point on!! I have a lot of siblings and half grew up in one corner of the country and half in another corner. The older ones have this thing they do when they see each other (which I don't get, but whatever) they say, "IT'S ABOUT TIME!!" That's not even funny in my book but I don't let it bother me. Not so with the drama queen. It takes such a small comment to just turn a fine time into a big hairy confrontation. I'm not even kidding. Picture a 50 year old that stomps around, slamming doors, smoking doubletime (because nicotine is so calming dontcha know), ranting and raving, and generally acting like a 5 year old because one little comment set them off. I just have to say, I was never so happy to drop someone off at their house when we got back to our hometown. I imagine I left skid marks!!! I've decided that after all this time of helping financially, listening to all the "woe is me, why does all this crap always happen to me??" for thirty years, I'm done. Unless there is strong medication and a whole bunch of therapy, I will not be going on vacation with my sister again. I realized that there is absolutely nothing that will make her happy. I'm tired of being tromped on when the only thing I've done is try to help. I'm going to try to be a little bit selfish and take care of me going forward. I'm going to try to get my stress eating under control. I guess I've gotten to the weight I'm at by emotional eating. I'm sure I'll be learning some new coping skills....and I still have my fingers crossed that my insurance will approve me for the biggest part of taking care of me!! My surgeon consult is on Tuesday!! It's finally near. So I'm putting the stress behind me. And I'm looking forward to my new beginning.