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Tricare Prime-under age 25 please help!!

Lilpeach_059

By Lilpeach_059, in Insurance & Financing

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Lilpeach_059    0

Lilpeach_059
Posted

Ok, I have Tricare Prime, and I need to know what is your "ideal weight" if you are under age 25?? Im 22 years old, and I think I meet the 100lbs over, and I had my PCM write a letter for joint pain, recurrent abcess and asthma. I wanted her to write "severe arthritis of weight bearing joints" but Ive never been diagnosed as that.

Tricare says they dont use the Metro Life chart (which is for individuals 25-49 years old)!! They (Tricare) said the surgeon has to say that it is medically necessary!! (Yea I know that but what ideal weight does Tricare use?) Ive spoken to a handful of reps and Im tired of calling! :w00t:

Someone please help, any advice is appreciated. I know I can just have the packet submitted, but I dont want to get denied! :blushing:

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Lilpeach_059    0

Lilpeach_059
Posted

Approved!!!! In a matter of hours!! I was worried for nothing!! Im 5'5 (had my PCM put 5 4and1/2), starting weight was 241 and like 256 (been on this road for a while) but I dont know which Tricare considered. Also had PCM write letter saying joint pains, asthma and recurrent abcess. Then I had the stuff that the surgeon made me do (psyc, pulm and nutrition consult and seminar and TSH level). Cant wait till im banded!!

Also my labs and consults were 1 and 1/2 years old!

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talkalot1981    5

talkalot1981
Posted

Did you get approved to have surgery or approved to just see the surgeon? I have a surgery date of July 28th, wish it was sooner but at least I have a date....Jennifer

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Lilpeach_059    0

Lilpeach_059
Posted

It says "Lap place gastr adj dev."

Place of treatment : (the hospital that the surgeon works at)

Case Type :Evaluate and Treat (and other services)Submitted Date:06/18/2009Approved Date:06/18/2009Type of Service:Bariatric surgery outpatient

one visit

So hopefully this is a yes!!!!:thumbup:

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Iris_L    0

Iris_L
Posted

It says "Lap place gastr adj dev."

Place of treatment : (the hospital that the surgeon works at)

Case Type :Evaluate and Treat (and other services)Submitted Date:06/18/2009Approved Date:06/18/2009Type of Service:Bariatric surgery outpatient

one visit

So hopefully this is a yes!!!!:)

Yes you were approved so now you can update all of your dates!!! :tongue: God Bless!! and congratulations

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Go To Topic Listing Insurance & Financing

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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