Another tricare approved

1000words · 05-16-2008, 07:40 PM

I was approved! My doctor submitted to the insurance on Wednesday, it showed up as pending on Thursday and was approved on Friday!

I called my doctor's office and they don't know when he will be able to get to me... he begins doing the surgery on June 9 and is full on that day... not sure when the next surgical day will be.

So hopefully I will be banded by mid-June.

AZChick289 · 05-16-2008, 08:18 PM

I am so happy for you .. I too am Tri Care and having my band done May 19th..
I am so happy for you and keep checking in with your Dr. The time will go by fast now that you know you have been approved .They will give you a window that will tell you when the surgery should be done .. Mine had a three month span I think.
Congrats .

IntoLess · 05-16-2008, 08:33 PM

This is great news! I am happy you got approved, I only hope mine goes as well!

eazes · 05-16-2008, 08:42 PM

Congrats...my PCM just put in my referral on Wednesday to see the surgeon. I hope everything goes as quickly as it did for you.

IntoLess · 05-16-2008, 09:51 PM

Check on your referral Monday morning, referrals usually only take a day or two to get approved. The lady who does our referrals put mine in on Thursday and I got a call from the surgeon's office on Friday to set up my initial appointment. The long part, at least for me, was between my initial appointment and the one on Monday for a re-weigh (I was 8 pounds under 100 over weight), a nut consult, psych eval, and exercise consult. I will find out Monday exactly how long it will take Joy to put in my surgical approval.

Keleka · 05-16-2008, 10:36 PM

Congrats on the approval! It's still reassuring to see TriCare approvals!!!! I'm just still waiting to get the referral to see a surgeon! I can't wait~

dlrwi · 05-18-2008, 08:49 PM

I'm happy for you! I have a question about Tricare approval? My surgeon said I have to have six months of supervised diet before they submit me to Tricare, I have my 3 month visit tomorrow so I'm half way there. Does Tricare require the six month supervised diet? Also, did you pay out of pocket for your psych eval or did tricare pay - those are the only two hold ups I have right now before having the surgeon submit my paperwork.

IntoLess · 05-18-2008, 09:05 PM

Tricare doesn't require the 6 month diet. They should cover psych eval, if you go through your PCM. My surgeon has psych, nutrition, and exercise consultants in his office, and makes everything so much easier. Maybe your surgeon is requiring the six month diet to see how you follow instructions, you may want to clarify with him and Tricare.

Ineedalapband · 05-18-2008, 09:38 PM

So you have to have TWO comorbidities? Also, what standard do they use for the 100 lbs overweight? Is it the PCM that needs these things to refer me to Tricare? I'm sorry, I just found out tricare would cover it and now I am starting my research. I've never been to my PCM here so I'm hoping he's accomodating. Thanks.

Keleka · 05-18-2008, 09:48 PM

I thought Tricare just required one comorbidity with being 100 pounds over weight or no comorbities if you were 200% over body weight. I just called my PCP last Tuesday and I thought they were just going to go ahead and fax TriCare for a referral for a surgeon for me. I think I would qualify under either requirement. I keep looking at the referral authorizations section on TriCare website but nothing yet

I guess since I made the decision to do this I'm just a little inpatient for something I know is going to take a while. I have TriCare Prime Remote so I'm not even sure what surgeon they will send me to! Good luck with everything!

Ineedalapband · 05-18-2008, 09:55 PM

Thanks for replying. I really hope its only 1. I was eclamptic with my last baby (a few months ago) and had a full on eclamptic seizure and emergency csection. My BP was up for a while after but seems to be coming down. I wonder if that would work? I need to go see about my BP. I don't have diabetes or anything yet, but it all runs in my family and I feel like its only a matter of time if I dont do something soon. Please let me know what you find out.

IntoLess · 05-18-2008, 09:57 PM

It used to be two, this is from tricare's website tonight:
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

Keleka · 05-18-2008, 10:00 PM

I know what you mean about doing something soon! I wish this would have been available years ago! I will keep posts on what i find out. BTW the only other comorbidity I have is blood pressure but only take a mild water pill for this. Keep posting on your progress as well!

Ineedalapband · 05-18-2008, 11:13 PM

Thanks Kitty. So it sounds like we only need one. I think I might be able to meet the blood pressure one. I'll have to go to my PCM and see if he'll help me out here. One more thing, the 100 lb limit is according to what chart? I'm 5'11" if that helps.

IntoLess · 05-19-2008, 08:42 AM

Met life ideal height weight tables references

Unless otherwise specified by your doctor, everyone falls in the medium category. I couldn't get a straight answer from anyone at tricare as to whether they go by the high end of the scale or somewhere in the middle.