Just found out on Friday that I have to wait 3 more months to get my surgery, and my surgeon is a jerk so I'm going to ask my PCM to refer me to a new surgeon and hopefully I can be done with thus process by next month. I just can't believe they would tell me that. I have tri care and my PCM approves of me doing thus so why should I have to wait 3 more months and they don't even try to work with me and my schedule and I have to drive an hour away to get there I mean come on!! This is some bull crap. I just want to give up so bad but my husband says I've come this far why stop now, it's just frustrating to here that you have done everything to lose weight on your own and when you need help with it they tell you no. I need a surgeon that can work with me and not cause all of this stress ????

I just don't know what to do at thus point I'm going to talk to my PCM Thursday and see if he can help me with this problem and find me a better surgeon . For the people that have tri care what did you do to make the process faster and have surgery in a time frame that wasn't 4 months down the road I can't wait that long. And who do I talk to with my Heath insurance about speeding the process up, I've written a letter but I think my pmc may have to talk to them about it....

If anyone can help me get throu this it will be greatly appreciated ????

I started all this in November and finally have a surgery date for next Wednesday I have Tufts Health Plan and the required 6 months of working with a health coach in there I can change program plus all the surgeons requirements Phycoligist nutritionist preop testing workgroups but it is here next week all I can tell you is I am very informed and know I'm making the right decision ... It will come quick be patient

Thank you everyone I just had to vent, I only have to get thro the next two months and my journey begins. I know I'm making the right decision my body can't take all of this working out I do ( 3 days a week of spin classes 3 times a day) I've gained a lot of muscle and don't know if that's a good or bad thing the weight that I was stuck at for 4 months was 206 and now I've been stuck at 210 :| but I'm not complaining I have lost inches do I'm happy with that. I just want to thank everyone for all of the support and words of encouragement to hang in there thank you

You're welcome! Sometimes you just got to let it out. I think we've all been there. There are always going to be bumps in the road but when all is said and done, you're gonna love the new you!!

My insurance requests 6 months weigh-in and I'm on my third' date=' but it IS so frustrating when you are mentally ready to have the surgery right away. Take the 3 months as a time to prepare for the surgery in terms of cutting out what you can so it won't be such a drastic change after surgery. Good luck and hang in there. It will go fast! :)[/quote']

Hey I'm doing the 6 month wait too I'm barely on my first one but I was wondering if you had to actually lose weight or have this be a failed attempt? I'm confused

Took me a year and a half to get cleared but so worth it.

Hey I'm doing the 6 month wait too I'm barely on my first one but I was wondering if you had to actually lose weight or have this be a failed attempt? I'm confused

Best advice.....call you surgans office and talk to the nurse who handles the claims / approvals with insurance. That person should.break down each "hoop" for you. ( ex. I could gain and still be approved by my insurance. However my girlfriend going at the same time as me with Different insurance had a strict no gain rule. If she gained no surgery. She did, and was postponed, put on liquid for one month th get it off n get approved ) call and know your insurance co rules. Your surgens insurance person should be able to break it down for you. Oh I lost time because my insurance had a strict 30 day weigh in w a Dr. I was late once (ok) second time I was late by 5 days I had to schedual an additional weigh in or risk being postponed. My GF.....could just report hers every few months. Different insurance.

Tricare seems to have different standards all around. They were able to go through a year of history and pull my 6 appointments. So at that point I just had to do what the dr asked which by the grace of God the base hospital appointments lined up like clock work (which honestly scared me). My longest wait was my surgeons date for surgery! Just keep the faith and know that the right time is coming for you! I wish you the best of luck with it all!!!

Tricare seems to have different standards all around. They were able to go through a year of history and pull my 6 appointments. So at that point I just had to do what the dr asked which by the grace of God the base hospital appointments lined up like clock work (which honestly scared me). My longest wait was my surgeons date for surgery! Just keep the faith and know that the right time is coming for you! I wish you the best of luck with it all!!!

The process would be faster if I lived on a base that had a hospital but I'm in Fallon, Nevada and I have to go to Reno to have my surgery done but I only have two more months of seeing my pmc and the real journey begins!!!

I had to drive over 2 hrs for my appointments and surgery. Which was so hard leaving my 6yr old behind (

Hey I'm doing the 6 month wait too I'm barely on my first one but I was wondering if you had to actually lose weight or have this be a failed attempt? I'm confused

There really is no clear answer to this. My sister was approved after doing 6 months and gaining weight. So far, I haven't been sticking to a diet really (shame on me) but I have made changes like only having soda one day on the weekend, etc. i have gained 2 pounds, but it's ok. Just don't fall below a 40 bmi!

Ok I talked to my insurance once again today and I got the clearest answer possible there is no guidelines the review it patient to patient I weighed in for my 4 th one and I gained 10 lbs over the 4 months they like freaked out on me at dr office so I was freaking out and called insuracd company and the rep told me best thing to do is for my next 2 weigh in get back to my start weight and even lose 5lbs if possible and atlesst it will show I'm deticated to get it but if I do nothing but gain now then most likely they will make me start over so it's time to buckle down next weigh in is sept 16th I could actually submit it now but my tenative surg date isn't until October 23rd so and last month weigh in is oct 9th so no point of submitting it with the gain if my surg isn't until oct and I dont want denial so I'm waiting it out

Insurance won't cover a dime of my rny bypass :'( which is kind of lame because I am type 2 diabetic like some people, BUT they will cover liposuction... Tell me how thy works please.

They won't cover your rny or rny in general? If its yours specifically find out why, diabetes is no joke. Keep trying!

All the luck

Surgery 7/25/12

Insurance won't cover a dime of my rny bypass :'( which is kind of lame because I am type 2 diabetic like some people, BUT they will cover liposuction... Tell me how thy works please.

I second Jenn - keey trying. The majority of insurance companies will cover rny if their requirements are met. Insurance companies live and die by economic statistics and the simple fact is, it's cheaper in the long run for them to pay for the surgery than it is to pay for all of the costs associated with weight-related co-morbidities. Many folks have been denied only to be approved after getting all of the t's crossed and i's dotted. This is the first time I have ever heard of an insurance company denying rny because of type 2 diabetes. I think I'd call back and discuss that with a manager if possible. That really doesn't make a lot of sense.

SusieB has a great suggestion as well. Surgeons offices normally deal with a multitude of insurance companies and they get to know their idiosyncracies pretty well. I'd discuss it with them as well and see what information they can give you about your insurance company.

If you're determined enough and persistent enough, there's a good chance that you'll get the approval. It's worth fighting for!!

One other thought - most insurance require a "letter of medical necessity" sooner or later. You might want to check with your primary care physician and see if he/she is willing to write one for you for submittal to the insurance company. Could go a long way toward helping your cause. Good luck and please keep us posted on your progress!!