Tricare

[RestlessMonkey 7]

I don't know if I want to laugh at the irony or be jealous of you two who are forced by our foolish insurance industry to GAIN weight to qualify for the band! LOL Good for you, anyway. Make the system work!

[jennybyars2003 0]

I know.. it truly is sad.. I know that I am over my 100 pounds, but the insurance company, which scales do they use??? who knows, it is almost like you got to play their game. we will see.. but right now, I am so stressed, that I have to find fun where I can.. LOL..

[RestlessMonkey 7]

Be sure and post to let us know!

[KarinaM 0]

I know.. it truly is sad.. I know that I am over my 100 pounds, but the insurance company, which scales do they use??? who knows, it is almost like you got to play their game. we will see.. but right now, I am so stressed, that I have to find fun where I can.. LOL..

Well here it is: I gained 30lb (did not reach the 100lb over by THEIR scale table), I also ate chocolate before my fasting blood test so my blod suar went up 103 and I shrunk 2 inches. I still got denied because of the 100lb. I guess I need to get some ankle weights????

Good luck.

[Maggies 0]

Karina, Sounds like you need to gain a few more pounds to be where Tricare will approve you. That is a sad situation because that is what everybody would do, so they should give it to everybody that is that close. At my group meeting yesterday a woman there said she had a friend that gained 60 pounds on purpose so her insurance would pay for her to be banded. Now that is SICK....... But if you are within 10, you should be approved. I have an upper gi appt. on Sept. 2nd. then the surgeon will submit to Tricare for approval. I am very nervous about being turned down because Tricare has paid out so much on me in the last year. Broke the top of my humerous in July 07, and have had 4 surgeries and it is still not healed. With the surgery I had on August 5th. being a bone graft. Today I was given a bone stimulator (ultra sound) unit that Tricare paid 3,000. for. It is mine to keep because they do not use them on more than one patient. But with that being said in all the years we have been covered by them we haven't used it much.

Have a good weekend everybody. Maggie:smile:

[aculberg 0]

aculberg, thanks for the info. Hopefully I will be having my surgery a week or so after yours. Going to Disneyland the middle of Sept, so not possible then. Does your surgeon require a preop diet? Maggie:cool2:

Maggies - I think I will have a week of Clear liquids pre-op, but I will find out more at my pre-op appt this Wed!! I am gearing up for that anyways, and trying to find all the Clear Liquids that I can, lol. Good luck!

[Maggies 0]

aculberg, I don't know yet if I will have any kind of preop diet. I guess I should wait to see if I'm approved to worry about that. The closer it gets to being submitted to Tricare the more I worry about it. Maggie:cool2:

[Airforcewife 0]

I would appeal - you have a co-morbidy of sleep apnea - that got me right in.

[rodriguezequal 3]

I have TriWest and I live in Washington. The surgery center that I went to said that no hospitals in Washington will take Tricare because they don't pay out enough or something...They said that if I wanted to go through my insuarance I would have to go to the army hospital...has anyone else had this problem or something like it?

[JamieNP 20]

Tricre uses the Met life scale and uses the figures for medium frame. And if you are 6 lbs under...well, you will get denied.

[Tuger 1]

Ok. I went to my PCM and she referred me to a weight loss specialist for the lapband. I went for my first appointment on Wednesday. I am so scared that I am not going to get approved.

These are my stats:

Height: 5' 3''

Weight: 226

BMI: 40.1

Medical conditions: Depression, PCOS & GERD.

I don't think that any of those are the medical conditions that they state that you must have.

My doctor said that Tricare has a thing where the patient has to be 100 pounds over weight. I am wondering if any of you have any advice or any dealing with Tricare.

I had to pay 200 dollars yesterday. I have a physc.. appoint on the 3 of sept. which is 65.00 and then I have a nutricianist appointment that is 100.00 and also alot of blood work and then they will send in the paperwork to Tricare to see if my package gets approved.

Does anyone have any advice for me..??

I am so ready for a life style change ...

Jenny

Check out the most recent (1983) Metlife scale. You need to know what body frame size you are first. For example if you are 5'3" and a medium frame, you will have to weigh at least 236 in order for Tricare to qualify you. Tricare uses the high end weight on each frame size. I know this for a fact because this is exactly what they told me. I was denied first for being underweight and now have another appointment for another weigh - in.

Height & Weight Table For Women1

Small Frame FrameMedium FrameLarge

4' 10" 102-111 109-121 118-131

4' 11" 103-113 111-123 120-134

5' 0" 104-115 113-126 122-137

5' 1" 106-118 115-129 125-140

5' 2" 108-121 118-132 128-143

5' 3" 111-124 121-135 131-147

5' 4" 114-127 124-138 134-151

5' 5" 117-130 127-141 137-155

5' 6" 120-133 130-144 140-159

5' 7" 123-136 133-147 143-163

5' 8" 126-139 136-150 146-167

5' 9" 129-142 139-153 149-170

5' 10" 132-145 142-156 152-173

5' 11" 135-148 145-159 155-176

Edited August 25, 2008 by Tuger
Fixed weight charrt

[JamieNP 20]

Tuger,

Tricare, in the denial letter, gave me a weight amount that I needed to weigh to be approved. It was the low end of the med build. For instance, I should weigh 227 lbs for 5'5 ht. I weigh 220.5. I fit in the small frame (no doctor stated what frame size I was so I guess they went by the medium frame). They stated that I needed to weigh 227 lbs.

[aculberg 0]

It sounds like some of the reps at Tricare are just being petty b/c I was about 5-7 lbs under the 100lbs according to the "metlife scale" and mine was approved, so like I said before, I think its whose desk your package lands on, and how picky they are! I do have a question though, how many that appeal still get denied? I cant find many so I'm just wondering.

[JamieNP 20]

I have not heard about any. I am working on an appeal letter, and going to weigh in sometime this week. I need to gain 1 more pound.:smile2:.

[jennybyars2003 0]

Tuger,

Tricare, in the denial letter, gave me a weight amount that I needed to weigh to be approved. It was the low end of the med build. For instance, I should weigh 227 lbs for 5'5 ht. I weigh 220.5. I fit in the small frame (no doctor stated what frame size I was so I guess they went by the medium frame). They stated that I needed to weigh 227 lbs.

Thanks ladies, these are the things that I really wanted to know. I really appreciate it. It sounds like I might have a fight on my hands. I wish all of you the best of luck and I will keep you posted on my status. I have my nutritionist appointment this Friday and the my Psych appointment on Sept 3. Then I guess that is when they send my package to tricare to be approved or denied. So I am just praying..