So I found otu today that my surgery has been denied and Tricare won't be covering it. I believe it's because I'm only 16 but my PCP is really pushing for it. We are going to try to appeal it but I'm so scared it won't work. I seriously can't imagine waiting untill I'm 18 to have the lap band. I wanted to be healthy and fit by then, I wanted to be able to live my life with out constant embarrasment by then. Yea I'm only 16 but I'm 5'1 and I weigh 271 pounds(and I've actually loss abit of weigth from the preop diet) I have back problems, I hardly ever get my period, and I can't go up a few steps with out getting tired. I really feel like I need this, nothing else has worked for me. I'm so worried, and feels like all my hard work has just been flushed down the toilet. :thumbdown:

Please don't upset...It's quite handy to be approved. For this you have to follow Patient Criteria for Lap-Band Surgery and many more things. If you need to get more information regarding with Lap Band Surgery and related topics please go through my Signature link as well. See the financing section and you will get information like:

• Patient Criteria for Lap-Band Surgery
  
• Appeals (How to Appeals & Where to Appeals)
  
• Patient Financing
  
• Self-Pay
  

And much more...So keep browsing and reading.

Also please see FAQ section as well...

Question: What information required qualifying for Lap Band surgery?

Answer: Your age must be in between 18 and 55, and Body Mass Index (BMI) between 35 and 40+ to be eligible for this surgery. Practically you should be in good health. Patients with severe and permanent medical problems are considered disqualified for this surgical procedure.

Hope this will help you a lot.

Thanks

Sorry to hear that!!! I can't believe how hard it must be to go through the up's and down's of emotions trying to get this surgery done. Keep fighting it! Work your PCP hard and get all the stuff you need to get this to work for you. May take 2, 3 or 4 times but beat these insurance companies down.

My wife is doing it here in one week though we are self pay. We knew that the insurance company would not cover the LB.

Good luck and keep us touch

Erick (Enote)

So I found otu today that my surgery has been denied and Tricare won't be covering it. I believe it's because I'm only 16 but my PCP is really pushing for it. We are going to try to appeal it but I'm so scared it won't work. I seriously can't imagine waiting untill I'm 18 to have the lap band. I wanted to be healthy and fit by then, I wanted to be able to live my life with out constant embarrasment by then. Yea I'm only 16 but I'm 5'1 and I weigh 271 pounds(and I've actually loss abit of weigth from the preop diet) I have back problems, I hardly ever get my period, and I can't go up a few steps with out getting tired. I really feel like I need this, nothing else has worked for me. I'm so worried, and feels like all my hard work has just been flushed down the toilet. :rolleyes2:

*

aww i just wanna give you a big hug! I'm so sorry! I really hate insurances companies! they suck! You could start college a healthy happy 18 year old..i mean geeze you are trying to get healthier...not be old enough to buy a packs of smokes! I dont know if its a US thing that you have to be 18 and over, but if it is, have you thought of going outside the US? They have done teenagers younger than you..

But I agree... call them (or have your parents call) and find out the EXACT reasons why they denied you and fight fight fight!!

They dont realize that this will save them SO much $ then covering longer term health problems!

GOOD LUCK!!

xoxo

Hugs!!!!!!!!!!!

Just continue to appeal. Appeal until you have none left. Tricare can be sticklers for their requirements. I wish you nothing but the best. Please kept us all posted and I will keep you in my prayer... Jennifer

Kaitlyn,

What about getting it done at a military facility? Mine will be done at Eglin Air Force Base in North Florida, bypassing Tricare.

Jeanne

Please appeal... and as the post above stated...try getting a consult at a military treatment facility (mtf) that does lap band surgery. i think a surgeon actually meeting you, seeing you and really listening to you in person, will go a long way (in addition to bypassing tricare). It may mean traveling to a large MTF..but do it if you can.

don't give up darlin...you will get there!

Edited June 30, 200917 yr by katwmn63

I used to have Tricare a few years ago and I was looking into surgery at that time but ended up just waiting. When I got my surgery done I had Empire.

Another option is you can get insurance through a job [i'm sorry, I'm assuming you don't have one?]. Anything so you don't have to pay out of pocket!!!!

Sorry to hear that. But as stated before, can you go to a MTF? Also do you have another parent, if so does he/she have a civilian job that offers a different health insurance plan?

Thank you guys so much for the support! Tricare Prime is the only insurance my family has, my mom called the actual surgeon's office today and he said more than likely I was denied because of my age because and because they can't garrantee I won't get pregnant in a year?! No way that's going to happen. Anways he said we have to wait untill we get the letter explaining why I was denied, then we can try to appeal it. My mom also made me an appiont with my PCP to see what else we can do. I know she's really pushing for it too. Your replies really do make a person feel better. So I guess it's not over yet.

im really sorry for you kaitlyn. i have tricare overseas and my PCM is giving me the run around too. he thinks im young enough to lose it myself. fortunetly for me, its not his decision. just keep trying and saving up. if you want it bad enough, it'll happen.

good luck hun!

Hey Kaitlyn ,

defiantly appeal , Maybe you could have your parents talk to the attorneys at obesitylaw.com, mine was denied and then Kelley helped get my denial overturned, They are wonderful there and they can lead you and your parents in the right direction. Keep us posted on how your appeal is going.

Hey Kaitlyn, I know that in some hospitals in the states they do studies on the lapband in children under 18 and sometimes it is funded so maybe you could ask around at your hospital?