You would think, after a lifetime of experiences that incontrovertibly show that no good ever comes from me being impatient and ramming through whatever decision I make, I would learn to STOP! Nope. I'm just not that smart... So...

I paid about $20k out of pocket for my surgery, when I could have been covered by EITHER of my TWO insurance companies. Allow me to elaborate... Tricare (my secondary coverage) guidelines I was able to find showed that Tricare would cover either bypass or band, not VSG. My clinic confirmed this information. My primary coverage also only covers bypass or band. My primary also requires a 6 month medically supervised diet before they will even approve a consult with a surgeon. So, basically I said "Eff you guys, I've got a health reimbursement arrangement, I'll just pay for it myself instead of screwing around with all your rules just to have to choose a surgery I don't want, to get coverage." So, I had my surgery less than 60 days from my initial consult.

I subsequently found out that I could have gotten my surgery done at the Army hospital in my area (completely free to me, of course...). That's what I get for relying on what I had found in the coverage literature and not actually seeing an on-post doc for a referral to find out what the MTF could offer that Tricare claims not to cover. Fortunately, this wasn't all that upsetting to me because I've had some bad experiences within the military medical system, and I would have been a lot more anxious about my surgery. Sometimes, peace of mind is worth a lot of cash...

The second blow came today when we were presented with information on our 2014 benefits at work. The insurance plan I have has decided to begin covering vsg starting next year with a recommendation from the facility performing the procedure. Had I done the 6 month diet (perhaps with the thought that I might decide I was willing to go with one of the other procedures since they would be covered... but no, once presented with the information, I generally make a virtually immediate decision with little or no waffling. One of the few situations where being decisive is a hindrance instead of a help!), I would have been ready to schedule at the beginning of the year. My insurance coverage is very, very good. I would have had probably less than $2000 (likely way less, because my secondary picks up a lot of what would be my out of pocket costs) in out of pocket costs had I known and waited.

Grrr... That's really all I can say. Grrr!

Well, I suppose I just got a really expensive 6 month head start...

Thanks for providing a space for me to type out my annoyance.

Maybe not so much, you could have given yourself a better chance for health. Let me elaborate. I am also military Tricare/ united health care now. I started trying to get approved originally for a gastric bypass in 2010 when I noticed that no matter what I did my weight would drastically fluctuate from 135-200 within a month. At the time I did not have as many health issues as I do now. I started the processes with Tricare for them to deny me, appeal, deny again and then switch health coverage and start all over. Long story short at the beginning of this year I was diagnosed with end stage liver disease, non-alcoholic cirrhosis stage 4. After all of the treatments, biopsy’s , and other mid-evil torture processes my transplant doctor tells me that if I would have had the bypass 2 years ago I wouldn’t be in the boat I’m in now. The gastric sleeve is my only option now due to my condition and I am currently waiting on a surgery date. Long story short, I started the processes with only having high blood pressure and due to the fast-food treatment of military medicine passing me back and forth between different PCP’s I now have hypothyroidism, diabetic, liver patient. They are still pressing the issue that I do not weight enough even though I have officially been passed over to a specialty care at KU Medical. I personally think you did the right move at being proactive at seeing to your health. If I had the capability I would have done the same thing. Try not to kick yourself in the shins for making a move for better health and not taking a NO for an answer. Personally, I salute you.

Daydra, ummmm, you are welcome... ???

Oh well.

Well it is what it is. Don't worry about that which you can't change. You did the right thing for you at the time......................

Maybe not so much, you could have given yourself a better chance for health. Let me elaborate. I am also military Tricare/ united health care now. I started trying to get approved originally for a gastric bypass in 2010 when I noticed that no matter what I did my weight would drastically fluctuate from 135-200 within a month. At the time I did not have as many health issues as I do now. I started the processes with Tricare for them to deny me, appeal, deny again and then switch health coverage and start all over. Long story short at the beginning of this year I was diagnosed with end stage liver disease, non-alcoholic cirrhosis stage 4. After all of the treatments, biopsy’s , and other mid-evil torture processes my transplant doctor tells me that if I would have had the bypass 2 years ago I wouldn’t be in the boat I’m in now. The gastric sleeve is my only option now due to my condition and I am currently waiting on a surgery date. Long story short, I started the processes with only having high blood pressure and due to the fast-food treatment of military medicine passing me back and forth between different PCP’s I now have hypothyroidism, diabetic, liver patient. They are still pressing the issue that I do not weight enough even though I have officially been passed over to a specialty care at KU Medical. I personally think you did the right move at being proactive at seeing to your health. If I had the capability I would have done the same thing. Try not to kick yourself in the shins for making a move for better health and not taking a NO for an answer. Personally, I salute you.

Thank you!

My goodness, I am so sorry that your health deteriorated so much under military care. While I've so far been fortunate in that I haven't had the same severe issues, I feel completely traumatized by my experiences in MTFs, mostly at Navy facilities, but also at Madigan Army Hospital. I, unfortunately, can relate to being passed around and dismissed. I, too, started the process of getting approved for bypass, I think it was around 2005 or 2006. I met the surgeon that I would have been assigned to, and I basically got a "what are you doing here, you should be dieting" attitude from him, and I totally bailed. Didn't feel like I could trust that he would have my best interests at heart.

I have been so frustrated over the years. At first, I didn't have periods (PCOS). I hadn't been diagnosed and we were trying to get pregnant. Despite not having any menstruation, my PCP refused to refer me out and forced me to wait a year before she finally consented to put in a referral to ob/gyn, where I finally was diagnosed. Even this doc that diagnosed my PCOS, who I actually really liked (Dr. Muffley... I just can't make this crap up!), performed a hysterosalpingogram (totally unsure if I spelled that right, an HSG at any rate) to determine if I had occlusions in my fallopian tubes, argued with me after the procedure was completed. I told him he "left a tube or something in me". He said that no, it's common to just feel like that after this procedure. Well, when I stood up and a significant amount of blood ran down my leg, it was clearly apparent that he had left the guide tube in my cervix. I had to send my husband for a maxi pad and someone to clean up after me. Every problem I've ever had seems to be because of my weight. I have spoon fed a doctor symptoms of anemia, knowing that was exactly what I had. She gave me hydrocortisone cream to put on extremely delicate skin that absorbed it very quickly. The physical sensations that caused made me think that My brain was going to blow out the top of my skull, like a blender without a lid, combined with a racing heart. That could have killed me, and I stupidly did what I was told. I have been asked why I came to the ER in the middle of the night when I was in my early 20's (really just a kid) and had this growth thing on the inside of my lip that was growing by the hour, like being scared was somehow irresponsible. I asked to have my Mirena IUD removed so that I could seek treatment from a naturopath to attempt to address my hormone issues, and the male doctor started asking me about what birth control method I planned to use, like I was some 17 year old kid, despite the fact that, at the time, I was over 30, had been married over 10 years, my husband was well established within the military, and I had a college degree and a professional career. He ultimately told me I was welcome to waste my money. I once saw a female OB and asked to have a tubal ligation. She started with telling me in an indirect way, that I was not old enough (30) to make that decision since I had not yet had kids and I might change my mind. When I explained to her that we had already been through infertility treatments and had realized through that process that we were only pursuing it because that was what society expects from a young married couple and we never really had any desire to have children and that we were very certain of and comfortable with that decision, she switched tactics and told me that I weighed too much to do it safely and she wouldn't do it unless I lost 30 pounds. I immediately began to cry and told her that I had tried so many times and didn't think I could do it. She talked me into the Mirena IUD, and then wrote in her notes that I "was not interested in weight loss". When I would finally be assigned to someone that actually had a caring demeanor that I felt comfortable with, I was lucky to see them more than once. I got to the point where if I was scheduled to see a male in uniform at a military treatment facility, the moment he walked it the door, I would start to cry, even if it was a twisted ankle or just a med refill. I had finally had enough, and got my own insurance so I didn't have to go through that anymore. I'm actually pretty comfortable with spending the money to prevent me from having to experience the anguish that I know I would have had to endure at an MTF, regardless of the talent or bedside manner of the surgeon. At this point, I simply am no longer capable of giving them my trust.

I'm in Public Health now, and actually provide some general training to the Navy docs in our area as part of their residency training (all our EH inspectors take turns). I'll spend a day out in the field with one to expose them to what the Environmental Health division is all about. It's actually kind of fun showing them what we do, and they are frequently amazed at some of the things we encounter in the community. I've had a chance to talk to some of them about the frequent transfers and how terrible that is for consistency in patient care. I've started to rebuild respect for them, because the docs that I've discussed this with hate the situation as much as the patients do. They would much rather develop relationships with their patients, and they find it personally difficult to maintain a kind and empathetic demeanor when an endless stream of patients they have never met before are forced through in 15 minute appointment blocks. The way the system is structured almost forces them to shut down any part of them that might respond to their patients with any kind of human connection. That admission gives me a lot of perspective for the position they are in, and I can understand how it could be difficult to maintain true caring for each patient when the system forces you to deal with them like cattle. I truly don't (and never really did) harbor any hard feelings for military medical personnel as a whole, just those with which I have had painful experiences. I definitely want to make it clear that I separate the deficiencies in the system and some specific negative experiences from the vast majority of good people that are just doing their best to work within an imperfect system.

I'm more annoyed with the timing of my primary insurance company deciding to cover vsg. Oh well. You can't know what you don't know. I will probably feel a lot better about the money when United Healthcare finally returns their denial and I can submit my reimbursement from my HRA so I can pay off my loan and cut $400/mo back out of my monthly responsibilities...

You know, I know it was really, really long, but typing out that litany of grievances with my experience with treatment actually felt kind of calming. A little like a bit of weight has been lifted off my chest. I never really felt like I had the interest or time for journaling, but puzzle pieces seem like they move around and fit together in my head differently and much more constructively when I'm writing than when I'm talking... I'm thankful this kind of forum exists, and that the vast majority of participants are kind and supportive. Thanks all.

Your eyes might be bleeding, but I feel better! (just kidding!)

Thank you all for your responses (and being part of my therapy session! ) and I hope you all have a good night!

AH Madigan Army Medical what a wonderful place to get lost in bureaucracy lol. We were stationed at Ft. Lewis when all this started. They were the ones that denied my cervical cancer, after one of their doctors had performed a full radical hysterectomy . I’m glad you are feeling better about your situation. I know it’s an inconvenience, but I still feel you made the right move to get the ball rolling. My conditions stem from digestive troubles which ultimately led to weight gain that led to other disorders. And the rest is history. I personally feel like military doctors are programmed to discourage what they consider elective surgery. I got the same response for most of the doctors at Lewis that I just needed to exercise. They lacked to realize I was quickly declining in the ability to do so even though I struggled through and dieted and exercised as hard as I could and still do. I have actually had a physician from a military installation tell me he feels that spouse’s use the services of the Army medical to get surgeries they don’t need. And it is this mindset that has most likely discouraged many people who need specific treatments in order to obtain better health. My disease came with no warning signs or symptoms and it was by chance they discovered the fibrosis of my liver while I was having my gallbladder removed. With every part of my being I implore everyone to ask questions about your liver before or after surgery for your own sake.

I wish you the best of luck and keep in touch on your progress J

P.S. No charge on the Therapy session, it’s my job jkjkjkjk ( I’m a psychology student..lol)

Thank you! I wish you the best dealing with all of your health challenges as well! We're up at Bangor, so fortunately, I've only been sent over to Madigan for just a couple things. It was really kind of funny... I got my own insurance to escape Navy Hospital and the Bangor branch clinic, but when I selected my own civilian doc, it turned out she was a former navy doc at Navy Hospital! She's good, though, as far as I can tell and I like her. She has not done or said anything that made me feel judged or marginalized. So much happier.

That kind of cracks me up that you're a psych major! My main circle of friends are all therapists and social workers. I'm the token science degree in the group! We are forever talking about how much overlap there is between their profession and mine. My friend that's one of the therapists says that I'm getting the precontemplative people that may someday find themselves in her office, at least she gets the people that are a little farther along... :-) (I'm a solid waste inspector. The largest portion of my work is responding to residential garbage complaints. I get to go out to the residences of people that for whatever reason (mental health, lack of funds, skewed priorities, substance abuse) are unable or unwilling to appropriately dispose of garbage and various types of solid waste. I get to walk up to their house, tell them they are failing to manage their affairs appropriately and that if they don't do what I tell them, I will be writing them a $500 ticket. I'm sure you can imagine how well that goes sometimes... I do my best to connect people with whatever help is available and seems appropriate, but I don't have any human services training and I'm pretty much winging it out there. Our agency is small enough that we only have a couple social workers, and they are both dedicated to the HIV program, so it's not really that easy to consult with them and nearly impossible to pull them out of their responsibilities to attend an inspection to provide guidance. It's good to have connection to my friends to run some of these situations by them. They always tell me that I could easily have gone into their field instead of mine. I tease them that there isn't any money in it. :-) I really wouldn't want to be a social worker or therapist, it would totally burn me, but I do feel like I make a good hybrid between enforcement and support. My fellow inspectors often consult with me or ask me to assist on delicate situations. That makes me feel good, like I've kind of carved out a niche for myself within the agency.

Anyway... way off topic (I suppose I can hijack my own thread if I want to )

I doubt that I'm really upset about the money, deep-down, otherwise I'd have spent a lot more time thinking about it. It just seems the whole situation is stooopid! :-)

Have a good night!

Not to switch topics butI have a Military primary care doc but having surgery by doc outside the VA medical center. Did anyone have trouble getting primary doc sign off because the VA was not doing the surgery?