Approved by Tricare? Post here plz

Lilpeach_059 · 01-18-2008, 01:47 PM

Hi everyone,

Im kinda new here but I have Tricare Prime (South) and I was wondering if everyone who has been approved or disapproved for Lapbad (since they have started approving Lap Band) will post here and include their starting weight, height, BMI and any comorbities, if any. Also, if you got denied, can you please include why you were denied. Thanks!!

mgordon1 · 01-19-2008, 01:39 PM

Hi - I was approved and have had my pre-op appointment with my surgeon and the hospital. My surgery date is 1/30/07. I am about 110 lbs over my ideal body weight - according to the chart and according to Tricare requirements, that alone was enough. My BMI is 43 and co-morb - blood pressure and chloresterol (sp).

From what I found out Tricare South should have the changes on line by no later than 2/1/08.

Lilpeach_059 · 01-23-2008, 09:58 AM

Thanks for sharing!

**Wheetsin** · 01-23-2008, 10:45 AM

My parents have TriCare Standard (I think...) and have submitted their paperwork to the surgeon. They should hear something in about 3 weeks, given the office's current load.

michellepom · 01-23-2008, 02:00 PM

I was approved by Tricare. I'm in the north region. I think I was actually the first one approved. My nurse found out they were going to start approving them on Jan 1st, and mine was approved on the 2nd of Jan. My surgery is for next Tuesday. I don't have anything wrong with me except knee, shoulder and back pains. My weight was 241 and I was 5.2... I'm not sure what the requirements are because everytime I call them they tell me they are not approving them yet. It's better to have your nurse call and talk to their nurses, (we are not allowed to talk to the people who actually approve the surgery)I get nowhere when I call with questions. It's such a new procedure for them they don't have it on their website yet. I did talk to my case manager, who could tell me the surgery was approved, otherwise I have had issues speaking with anyone else. My best advise would be to ask your nurse to call and ask them what the specific requirements are and then have her put through your request.
Good Luck!! The only extra thing they wanted me to do was an upper GI, and then they approved me.

Emily'sDad · 02-21-2008, 10:07 AM

my referral to the surgeon has been approved. Haven't yet been approved for the actual surgery. 305lbs 6'00" BMI 41. Cormobids; high bloodpressure, sleep apnea, and back pain.
My impression is that I've made it through the difficult part of the approval process. We will see though. I'm still keeping my fingers crossed that all contiues smoothly.

Emily'sDad · 03-01-2008, 02:43 PM

I've been approved for the surgery too!! March 25th!

Tantrica · 03-03-2008, 07:37 PM

I have Tricare West Region, Prime and have done all my pre-ops and will have my paperwork submitted for surgery this week. I'm not expecting much hassle. I'm 29, 5'6", 245 lbs, BMI 40.8 with HBP, arthritis of weight bearing joints, and fatty liver disease. My surgeon is confidant that they will not deny and I should be banded in late March/ Early April! I did find that in order to actually GET the referral I had to be assertive, direct, and not take any garbage from my PCM. She actually had the gall to tell me that Fat people are fat because they WANT to be and if I wanted to be thin I would be. After that remark I lost my cool and quit asking for things, I just TOLD her what she was going to do instesad. I met with the surgeon on Jan 16th, and just finished all my pre-op testing on Thursday. Remember to be assertive, this is your life and health! Don't let anyone stand in your way when you are trying to make it better!!

Kari

justmee · 03-04-2008, 10:27 AM

I have been approved to see the surgeon: Dr. Sebesta, at my MTF. I have also been approved for Nutrition and Psychiatry. I have already done my sleep study. However my case management referral was denied pending more information (???).

What steps have others had to take? Anyone else seeing D. Sebesta?

Thanks

minpinmom · 03-04-2008, 10:48 AM

I can't believe I haven't posted here - I was approved on 1/29 and had surgery on 2/19! I had no tests required by Tricare. (I didn't have any co-morbidities) The tests are going to be required by your Dr., not by Tricare, unless you are trying to prove a co-morbidity. I am 5'4" and weighed 259lbs.

Tricare is now the easiest Insurance company for Lap Band. As long as you meet their weight/height requirements you are approved! My approval (once Tricare received it) was approved in less than 1 day.

Good Luck!

Tantrica · 03-05-2008, 12:49 AM

Quote:

Originally Posted by Tantrica

I have Tricare West Region, Prime and have done all my pre-ops and will have my paperwork submitted for surgery this week. I'm not expecting much hassle. I'm 29, 5'6", 245 lbs, BMI 40.8 with HBP, arthritis of weight bearing joints, and fatty liver disease. My surgeon is confidant that they will not deny and I should be banded in late March/ Early April! I did find that in order to actually GET the referral I had to be assertive, direct, and not take any garbage from my PCM. She actually had the gall to tell me that Fat people are fat because they WANT to be and if I wanted to be thin I would be. After that remark I lost my cool and quit asking for things, I just TOLD her what she was going to do instesad. I met with the surgeon on Jan 16th, and just finished all my pre-op testing on Thursday. Remember to be assertive, this is your life and health! Don't let anyone stand in your way when you are trying to make it better!!

Kari

I just wanted to let you know that my insurance packet was submitted to Tricare today and just about 3 hours later I had my approval!! I am set to be banded 2 weeks from Thursday!!

KAri

Emily'sDad · 03-05-2008, 11:42 AM

Tantrica
I can relate to how your PCM reacted. My PCM told me, "we all have to exercise regularly, this includes you." No kidding? I actually go to the gym 3 nights a week. I'd say that is pretty darn good in comparison to most folks.