So finally, after months of trying to get my prior auth from my PCM, I got it and my appointment with the psychologist is tomorrow.

According to the psychologist's office I will be taking an MPMD, and MMPI II in addition to the one hour interview. However, I think Tricare Prime is only covering the interview.

So I have a call into my surgeon's office to see if the other testing is required by them, or just other insurances. Regardless, if it's a requirement of the surgeon's office, then I will suck it up and pay out of pocket.

Also I've had my initial consult with the surgeon and once they receive my psych eval, everything will be submitted to Triwest for approval. How harmful would it be to try to start losing weight now, on my own? Just making healthier choices similar to what I'll have to do after the band and working out more? Or do I need to stay fat until the day of surgery?

I don't think that they are going to re-weigh and send the new weight to the insurance company once everything is already submitted. If you are unsure, contact the surgeon's office to ask them. Approval shouldn't take THAT long once the psych eval is received. Your surgeon's office staff probably knows about how long each insurance company takes. They do this all the time.

You should contact your surgeon's office and see what kind of preop diet is required. Many require 1-2 weeks of liquids sometimes with one low carb meal per day. I wouldn't start THAT yet, but reducing your carbs would help start the liver shrinking process and help you get adjusted to a new way of eating.

Good Luck!

I talked to my surgeon's office and the two tests are not required by them, nor by Tricare. However it may be required by the psychologist. So I will call there and ask again tomorrow when I get there. No need paying big bucks for things that my surgeon and insurance don't want/need.

I also asked them if losing weight now by trying to live a healthier lifestyle would affect my approval/denial and was told to go ahead as they would be submitting my weight at the initial consult.

GERD and borderline hypertension are the only co-morbidities I have, with a BMI of 40.9. I hope that is enough to get Tricare to approve me.

If you have already been approved by the insurance company, then your initial weigh in will count as your starting weight. But a word of caution regarding losing weight now. My insurance company assigned me a case manager.

The case manager happened to be a nurse who had WLS. She clearly told me not to lose any weight, specifically not to go under a BMI of 40, until the insurance company approved me to see the bariatric surgeon.

Now the insurance company approved me to have the 6-month supervised diet and the pysch eval, but they had not yet approved me to see the bariatric doctor. This was a very stressful time, because here I am on this 6-month supervised diet, trying not to go under a BMI of 40, in fear of being denied. Crazy!

Once I was approved to see the bariatric doctor and she weighed me in. That was considered my official weight for the insurance company. After that, I was approved for surgery and started losing weight in preperation of the surgery.

Not all insurance companies are like mine. This is just my experience and may not yield the same results for you.

Good luck!

I've already had my initial consult with the bariatric surgeon. The only thing they are waiting on is the psych eval and then they will submit to Triwest for approval of the actual procedure (surgery) and follow up care.

Does anyone have any advice on what to expect at the actual psych evaluation?

Edited January 27, 200917 yr by dl2418

Bugt anyone have any advice on what to expect at the actual psych evaluation?

I spoke to the psych doctor for about 30 minutes. And then I completed a questionnaire at his office. I believe it was around 200 questions, multi-choice. I spent more time with the questionnaire than I did with the doctor. The questions were basically all the same but asked in different ways.

Do I follow doctor's orders? Do I do things on my own without following orders? Do I feel suicidal? What type of support system do I have? Do I cheat?

Hi!

Good luck with your quest. My only advice regarding the psych eval is "BE HONEST" we fat people lie. We lie to ourselves, we lie to our families, we lie to our doctors. That's one of the ways we got fat. The psych eval will let them know how committed you are to this whole process and how well you are likely to do as to following the doctors reccomendations so like I said. BE HONEST!

I talked to my PCM for 5 minutes about the lapband, he looked at my current weight and height and automatically said yes. I just barely made the requirements for it. Tri-care will approve you, they are just extremely slow. I go friday to schedule an appointment with a surgeon. You may want to try calling Tri-care to see if you can speed things up a bit :cursing:

Well, that was a long 4 hours! But after doing the testing, and the interview, she says I'm good to go. :bored: So she will send the paperwork to my surgeon, who will then submit my case to Triwest for approval. I should know something next week as the approval time is about 72 hours. Keep your fingers crossed for me, please!!!!!

Well, that was a long 4 hours! But after doing the testing, and the interview, she says I'm good to go. :bored: So she will send the paperwork to my surgeon, who will then submit my case to Triwest for approval. I should know something next week as the approval time is about 72 hours. Keep your fingers crossed for me, please!!!!!

Wow! 4-hours is a long time. Congrats and good luck!

Wow! 4-hours is a long time. Congrats and good luck!

Well I had to do a 200 question MBMD, then the MMPI II that was was over 500 questions, a one hour interview with her. Then she reviewed the results of my tests and another 40 minutes for review.

Now I just hope Tricare approves it!!!