I just got the news from Tricare today that I have been denied for the Lapband.

I'm really upset about it because it was something I was very much looking forward too, I even saved some of my "skinny jeans" just incase I would loose the weight.

They denied me because they said my co-morbidities were not severe enough. I have Polycystic Ovarian Syndrome, Plantar Fasciatis and Arthritis in my knees. But that's not good enough. Even though I wake up in the morning and can't walk because my feet hurt (the fascitis), it has to get bad to the point where I would need surgery for that before they would approve me. Or I would have to contract Diabitis from the Ovaraian Syndrome. Or IDK...have my knee amputated above the knee before I can get the Lapband. I'm so mad right now I'm typing fast and I know I just misspelled like 8 words in there.

I am 110 lbs overweight, in very much mental and physical pain because of it, and they don't see it! Supposedly I have to wait a min. of 6 months or even a year before I can reapply.

But the worst thing of all is dealing with my anxiety about my husband seeing me (with all the weight I've gained since he deployed) and not being attracted to me. It's enough to make me go insane.

You can still have it done... finance it!!

have you had a sleep study? a dx of sleep apnea may qualify you?

can you appeal? maybe have your PCP or Lapband Surgeon to write a letter on your behalf? if financing isn't an option, i would do a search here on some who have been successful with appeals.

good luck to ya!

Hey, My insurance denied my claim, however I am still about 300 pounds over weight. I am going to pay cash price for it. You could do that too by paying monthly or a loan. You can't put a price on being healthy for the rest of your life.. Good luck to you. Wish you the best. Hang in there

I'm sorry you were denied and it's causing you so much pain.

I have Tricare and had my surgery last Thursday. I too have plantar fascitis and have gotten some relief with getting cortesone shots and have to wear a night splint. The podiatrist has told me he would do surgery on my feet but I told him I wanted to wait until I lost some weight before considering that option.

These were the guidelines for me to get approved for surgery ( have many listed plus), so I'm not sure if any of yours fall under these guidelines.

• Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints
  
• Is 200 percent or more over ideal weight for height and bone structure
  
• Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery
  

Hang in there sweetie.

Hi, I was denied also. They claimed that basically I wasn't fat enough. And my co-morbities weren't the ones that they listed. So I sent an appeal later. Stating all the things that were wrong that they might not recognize, but that the National Health Institue does, ie Osteoarthritis (torn meniscus in both knee's) Acid reflux, depression etc. I read that alot of insurance companys will say"No" right off the bat just because most people will just take that as the final answer and give up. But if your presistant alot of times they change their mind. They did for me. Everybody else is right , there are lots of possiblities out there to get it done. Good Luck:thumbup: Susan

Go to carecredit.com and apply for it. Great company.

Are you on meds for PCOS? I have it too and I have Tricare I'm going for a referral tomorrow for the lap band. I am worried they won't approve me even though I have a lot of their co-morbidities. I am on metformin for the insulin resistance because of PCOS. I also recently had gall bladder removed which is cholecystitis. I have a severe family history of heart disease (my dad had heart attack at 28). I am also a little over 100lbs overweight. I am hoping to get approved. Good luck on your appeal! I would definitely talk to your PCM about what you can do.

Get a sleep study showing you have sleep apnea and tricare will approve the surgery. I went thru the same thing with tricare. I had the study immediately after my first denial and re submitted my request and was approved within 10 days. I never even had to change my surgery date.

im sorry to hear that hun, the same thing happened to me....they refused me lapband surgery but then said that they would pay for bypass?? Now does that make sense??? go figure!

anyways to cut a long story short, i know that bypass is definatly not for me so im self paying...like someone else said there is no price to high to get your health back into check. its taken me 4 months to save, but even if it took me 12 months, i would still save and get the surgery. please dnt give up...there are other ways to get it.

xx

I was denied also and just would not take no for an answer. I went to the qualifying supervisor and had her review it. I think it is all about who gets a hold of your file. Just drive them crazy, that is what I did! Banded last week!

Hey I would read the insurance company's rules on appeals. I appealed to both the insurance company and thru my state's 3rd party appeal process. What I was most shocked by was the number of documents that the state asked me to re- supply. Meaning they didn't make it from the insurance company's files - my guess is if the file is incomplete it makes it easier to say no. But anyway the appeal worked try it before you self pay. You will have to wait 30 days or so but it better then spending 12K

i hope things work out for you doll, keep trying!

Appeal, Appeal, appeal. I can't say it enough, never give up after one try. I came into this expecting to be denied, I had everything ready to go to fight Tri-Care and the hospital. Turns out I didn't need too. Check to see if the local military hospital is offering the lap band, if they are that could be why tri-care denied. If they aren't keep fighting, tri-care likes to sting you along, just appeal the denial, and keep appealing it.

My surgeons office said that Tricare is approving everyone. Perhaps your doc had the wrong codes, maybe they didn't have everything in?? Call Tricare and find out exactly why you were denied.