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Tricare question!

Felisha

By Felisha, in Insurance & Financing

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Felisha    0

Felisha
Posted

Has anyone been approved with BMI/weight alone?

I have SEVER back and hip pain and am only 20 years old. I'm hoping to get surgery but now I'm starting to get very very worried.

They said I need BOTH weight of the 100lbs over and a whole long list of things. And I haven't had my physical yet but I don't think I have any of the other requirements.

So, Has anyone been approved w/ BMI/weight alone and how long did it take?

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Rsilversea    2

Rsilversea
Posted

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.

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Felisha    0

Felisha
Posted

My BMI is 44 and I'm .5lbs over the lowest number for lapband surgery in the 200% mark but my surgeon said I need to gain 13lbs.. idk why

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Rsilversea    2

Rsilversea
Posted

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.

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Felisha    0

Felisha
Posted

Appeal appeal appeal!

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Rsilversea    2

Rsilversea
Posted

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.

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lucybugsmama    0

lucybugsmama
Posted

I'm in the same boat. I went for my consult with the lap-band surgeon today and they said I'm in the range and are submitting to Tricare. I'm really worried that I won't be approved because the only comorb I have is reflux and that's not listed as a qualifier with Tricare.

I had bloodwork done a week ago and haven't heard back from that. It sounds relly messed up, but I'm hoping for high cholesterol or thyroid problems to up my chances of approval.

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Rsilversea    2

Rsilversea
Posted

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.

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Rsilversea    2

Rsilversea
Posted

Doctor's appeal letter is going in today.

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lauragshsu    6

lauragshsu
Posted

I have tricare and had a BMI of 44, and got approved within 5 days of it being submitted. If you have any type of family history of any weight-related health problems, flaunt it to them. My dad was just diagnosed with diabetes and has high blood pressure and cholesterol. I made sure all that was included in the report the Dr sent to insurance.

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Felisha    0

Felisha
Posted

My mom has weight related sleep apnia.. would that work? And I think she has HIGH blood pressue.

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lauragshsu    6

lauragshsu
Posted

My mom has weight related sleep apnia.. would that work? And I think she has HIGH blood pressue.

I would definitely have the Dr include it. ANY type of ammo that can be used to win should be included.

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FattyCakes    0

FattyCakes
Posted (edited)

I called TriWest today b/c my friend told me that they'd approve me on BMI alone. The lady read out-loud just what I read on their web-site (with no mention of BMI) and I mentioned BMI and she said, yes you can get approved on BMI too. I asked her how she knew that and she said she's been trained on it. I told her I was scared that if I called back that someone else would say no..... So, it's not written in their policy that I know of, she's "just been trained." :thumbdown:

Edited by FattyCakes

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rucsac1971    0

rucsac1971
Posted

Well, I go for my consult today. Went and saw PCM on the 16th of April for the referral. Got that instantly almost now the hard part begins. I have the lab work results from that appt to take with me. It states that I have high chlosterol but barely but doctor also noted that the lapband surgery would correct the high chlosterol. Also taking with me results from sleep Study done several months back. I did not need the CPAP but doctors recommendation was weight management. Hope this is enough. Thought??? Tricare South Prime

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Rsilversea    2

Rsilversea
Posted

BMI is NOT in their policy although the policy is currently being rewritten. It may take 6 months to a year for the change to take place though.

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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