Rsilversea

Doctor's office is sending in appeal today. They are using the weight I was when I was first weighed and my correct height. Haven't received my denial letter so I haven't sent in my appeal. Hopefully I'll have good news by the beginning of next week.

Ho ho ho? :thumbup:

I'm working on my appeal letter today. They have 30 days to respond but my doctor's office said they normally respond in five (I'm guessing that's "normal" insurance companies not Tricare). Hopefully I'll know by the end of next week or beginning of the week after.

Until Tricare updates their standards, you will never get approved on BMI alone. I don't suggest gaining the weight just to get the surgery because I believe it will harm you in the long run.

So po'd! My doctor's office never measured my height so I was denied by Tricare. Now I'm officially 12-20 pounds under their current standard for surgery approval. It doesn't look like I'll be getting surgery done even though my BMI is 40 because Tricare is behind the times with the rest of the nation. They still use the outdated MetLife height/weight chart! Spitting mad and depressed. Hubby just wants me to lose it on my own and can't comprehend how difficult that is for me. So now we are arguing. He thinks I'm giving up on losing weight (and he may be right). I can't reach my nurse at the doctors office and don't know what to do.

Well, as I stated in another thread, I was denied but my doctor is going to call Tricare. I've been told that once the doctor has spoken with insurance companies, they usually give approval. I hope so since I've been stressed out about this.

Well, I was just informed that I was denied. My doctor is going to call Tricare and give them hell, lol. Apparently they are rewriting the policy but it won't go into effect anytime soon. I may have to go through an appeal process but I hope to find out something more definitive from the doctor by the end of Thursday.

My doctor has also scheduled my surgery in advance of approval. He's never had problems with anyone with my insurance getting approval but they are dragging their feet in my case. My doctor is thinking he will have to reschedule my surgery and if, by some bad stroke of luck, my insurance denies me he's going to appeal.

It's been almost 2 weeks and I'm still waiting. My BMI is 40 and I'm in the ballpark for Tricare's policy but they are haggling over something. No clue what and my doctor's office is frustrated with them. So am I. I may have to adjust my surgery date because the doctor's office can't get in touch with the case manager and they needed an answer by noon today. It's past noon and I have not heard anything.

Sounds like it's time for a new boyfriend. Sorry to be blunt but he doesn't sound like a winner.

I haven't had my lap band surgery yet but I have had my gallbladder removed. From what I can tell, they are done the same way and my surgery was pretty easy.

Venting helps to so vent away. And maybe you have a support group nearby you that can help? Also try talking to your doctor. He may be able to give some advice. I certainly understand stress and "not caring". I'm under some stress since I'm still waiting on approval from my insurance and it seems to be an uphill battle (certainly nothing compared to what you're going through!) You obviously care since you are (a) posting here and (:eek: are worried about gaining weight.

I haven't told any of my family. I have told my husband's family as they are supportive. My feeling is, if they can't or won't support you, find some friends who will. Also, attend your support group. They will be a big help.

I apparently don't have any co-morbidities (because they aren't treatable yet). My BMI is over 40 but my insurance (Tricare) is not consistently applying the rules to everyone. My surgeon has sent me everywhere trying to document possible co-morbidities for me. Talk to your surgeon, as he may do the same.

I know my insurance won't cover cosmetic surgery unless it's medically necessary.

Still fighting with Tricare. Had to get some x rays done today but I doubt that will help. Now I won't know more until Monday at the earliest and hopefully no later than Wednesday.

The most frustrating thing about Tricare is their lack of consistency. Some people are approved or denied based on BMI and others have to go through old standards. I just talked to my husband who e-mailed my doctor the Tricare policy because Tricare is trying to hold me to the old standards. I had to get re-measured and reweighed today PLUS I have to get x rays done on my knee and ankle to see if I have osteoarthritis. Apparently my other co-morbidities are good enough for Tricare. Heaven forbid I'm trying to better my health and keep them from paying out more money later for other surgeries and medications. (rant completed)

Oh wow! I have to go see my doctor tomorrow to get measured since Tricare is being fussy. I hope I get approved too. The doctor is going to do all he can to make sure I do. I'm even getting a photo ready to take with me because the nurse said Tricare asked for one! I sure wish Tricare was more consistent. My nurse told me she had other Tricare patients and as they met the standards, I should too. Hubby is stressed big time. It's starting to rub off on me. Congratulations!

So Tricare is being difficult and hubby is sweating bullets. The doctor's office is confused because they say Tricare is not being consistent and using outdated regulations. I have to go in and get measured. Hubby wants to know if anyone has appealed a denial to Tricare and been approved and if they have a copy of their appeal letter.

Hah! I've told everyone BUT family, at least mine. I don't need to hear my dad's "advice." My husband's family is supportive at least.

We will be able to fit into those stalls made for ultra thin super models?! Oh yeah!! No more handicapped stalls for me soon!

If you mean by "diet", watching what and how much you eat then yes. You won't be able to gorge on a banana split or a load of wings. You will have to eat small meals. I've started weighing my food so I get 2 oz. of meat, 1/2 cup of starch (rice or potatoes) and 1 cup of vegetable (assuming I can find one I actually like). My snacks consist of fresh fruit or sugar free pudding and I try to keep it to two a day. Not easy right now since I'm not banded and I keep getting hungry. I hope it will be easier afterward. Don't think of it as a diet, think of it as a healthy lifestyle because it IS a lifestyle change.

I haven't had the surgery done but it probably depends on how you react to those things. You will probably be able to eat them just not near as much as you used to. Ask your doctor. He will have the answer. Just remember, you CAN have the band removed but more than likely you will gain back what you lost and maybe then some. This is a life-changing event. Do you want to be healthy? Do you want to look and feel great? The band can only do so much. You have to want to make the change to healthier foods (you may not even want to eat those after the band!) You want stop eating, you'll just be eating healthier.

Ahhh, parents. That is why my father will not know until after I have the surgery. When I was a teen, he told me that I could be really pretty if I just lost some weight. Then he told me I would look slimmer if I just stood up straight. He also told Mom one day, "Why don't you just slap that on your hips? That's where it's going anyway." Now he's probably around 300 pounds and looks like hell. Let me tell you what I am anxious about. I'm worried that I'm going to fail, that I will gain back what I lose and then some or I won't lose at all. I'm not worried about surgery. The mortality rates are extremely low. Getting this done will be the greatest thing for us. I can remember the one time in life I was skinny. I had confidence, I felt great. And guess what, it's going to be that way again. Keep the course! You're doing great!

You ARE a success story! And an inspiration! Keep up the great work!