BMI of 34.1, TRICARE STANDARD, MEM MED IN SAV WON'T SEE ME

[faithwade 2]

Wow. That's horrible. I would send a letter marked "confidential" directly to the surgeon. Doctors rely upon their staff to be the front line "face" of the practice, and are often unaware when they have snarky office help (since the type of people who like to play power games of those sorts are generally incredibly nice to the doctors). If nothing else, the doctor needs to know that his staff is refusing to allow you to speak to the office manager.

And I agree with nayttap--send the letter, but move on to another surgeon (and be clear in the letter that you are doing so because his office "help" was singularly unhelpful).

That's what I would do, anyway.

Lizzy, a different person from their office called me Thursday and asked if I'd like to come to a seminar. I explained that I'd already been to one, and that I'd been speaking with Megan, who told that I don't qualify, and wouldn't be able to see the doctor. She said that she had no record of me being at the seminar. I asked to speak to the office manager. She said yes, put me on hold, then came back and told me that the office manager was unavailable, but would call me back Friday. I haven't heard from them since. I'll send a letter, but I truly doubt that the doctor will ever see it.

[LVGirl 4]

What TriCare do you have? I have TriWest and I had to be at least 100 lbs overweight with at least 1 co-morbidity or 200% overweight. TriCare is strict with their rules but it is a fast process once all is said and done. I am 5'7 and weighed 275 when I started the process along with hypertension (I had a BMI of 41 but they did not take that into consideration).

Have you gone to TriCare's website or spoken to a patient advocate? I think they will tell you the same but if different regions have different standards%2

[WEESIE 5]

Congratulations on finding a good fit for a surgery center. This shows the importance of doing our research. It might be a longer drive, but you will be with a caring team during your pre-op and aftercare visits. We'll be looking forward to you getting your approval soon.

[faithwade 2]

Hi, Im Tri-Care prime, and live in TX, and I know for us, you have to be 100lbs overweight (BMI doesnt count) with co-morbitidies, or be 200lbs overweight without them. With the place I went, the doctor wouldnt even see you unless you qualified. I rarely saw the actual surgeon. Only once before the surgery, the surgery day itself, and now when I have fills. His staff did everything else. If you dont like them, dont go there, because they are your support group. They are the ones who are supposed to help you through everything, from the first day you walk in the door, to the surgery, to all the post op care for years to come, so please dont go to someone you are not comfortable with.

Its wierd that Tri-Care has different standards for different regions, but you should go to their web page, then type in your zip code, and see what their standards are. The website is www.tricare.mil and it walks you through it. Like I said, I have tricare prime, and I had to be 100lbs overweight according to my height on the Met Life scale, and my surgeon said that Tricare requires them to use the "medium" body frame for everyone. If you google the "met life weight chart" you will find it.

After all that is said and done, find a surgeons office that you like, and go to them with the knowledge that you DO qualify. Tricare requires a visit with a psychologist, and most surgeons offices require a visit with a nutritionist and once all that is done, it takes about 4 days to get an approval from tricare. They are the fastest insurance.

If you have any other questions, please feel free to ask. This process is so much easier when you know someone who has had to deal with the crap first, and can guide you through it!! Good luck

Thank you so much for responding. I was so discouraged, but I've researched tricare and lapband a lot. As of March of this year, Tricare requirements have changed. You have to have a BMI of 35 with 2 comorbidities to qualify. I may even be denied at first, but my new surgeon is aware of this, and works closely with Tricare to get his patients approved. They do still use the Met Life scale, and the surgeon has to mark "small" body frame specifically. Met Life also adds an inch to your height, automatically assuming that you'd be wearing shoes when measured. My doc specifically states that you're not wearing shoes on the form for that reason. I've already had my psych visits (approved), and will meet with the nutritionist and exercise physiologist this thursday morning, and then my first appointment with my new doctor is that afternoon. I'm so excited! I hope I get approved!!

[JLynn288 0]

I've had LOTS of problems with Memorial Health Bariatrics in Savannah. I went to their seminar last Wednesday, and was told by their rep that I'm not big enough to qualify for the surgery. I'm 5'7, and currently weigh 218 pounds. The receptionist who was taking our paperwork told me that the doctor probably won't even call me back, because my BMI is too low. She didn't ask about my co-morbidities or history. She didn't ask me anything. The woman sitting next to her asked me if I was just doing this to get ready for bikini season. Another woman in their group told me she thought I was post lapband, and to go home. I don't need the surgery. I know that I'm not as big as a lot of people, and there are some who may need the surgery more than I do, but I'm still almost 80 pounds overweight, and have 2 comorbidities. Anyway, I called Mem Health a couple of days later, and the same woman from the seminar answered the phone, remembered who I was, and refused to make an appointment for me to see the doctor or let me speak with someone else. She told me that she considers me a self-pay patient, and asked me if I could afford to pay for the surgery our of pocket. If so, then she'd be willing to set up an appointment for me. I told her that I'm a tri-care standard patient, and that my current BMI is 34.1. I also explained that I have stopped taking the prescription phentermine that I'd been on for the past 3 months, and that in 3 weeks I've gained back 8 of the 25 pounds that I lost while on the diet pill. I also told her that my primary care physician faxed a letter to her practice explaining the reasons he feels I need this surgery. She told me that his letter didn't mean anything, and that she doesn't have it anymore (I guess that means she threw it away). She then told me that in her professional opinion, I do not need the surgery. I asked if I could speak to the office manager, and she wouldn't let me. She said that she'd discuss the matter with the appropriate people, including the doctor, and that they would make the decision together as to whether or not they would call me back. I just told her to throw my paperwork away.

Has anyone else dealt with these kinds of problems? I'm just so upset...

I have tricare prime and live in Alabama. Now for me just to be seen by the surgeon I had to get a referral from Tricare. This was based off the doctors recommendation. From there each surgeon has their standards. Lap band now has a BMI standard of I believe 34 and at least 2 co-morbities. But my doctor said that I was close at 41. So I'm sorry to hear its been hard for you to even be seen. My suggestion is to get a refferal and if that doctor doesn't want to work with you then they will help you find another. Good Luck!!