Denied by Tricare!! 6.5 pounds under!!

JWRN · 08-19-2008, 02:53 PM

My surgeon and I thought for sure that I would be approved by Tricare. I have two major comorbidities.
I am 3 pounds over the low end of the Met life scale...but Tricare told me today that I am 6.5 pounds under the requirement! You have got to be kidding me!!!
So, do I try to gain the 6.5 pounds?? or just give up and go on ANOTHER diet!!

LiveLoveLaugh · 08-19-2008, 03:03 PM

Gain it and go for it!!

LiveLoveLaugh · 08-19-2008, 03:04 PM

Really that could be a poop!! Also add some rolled coin in your pocket next weigh-in!! Works really well!!

tomatogirl · 08-19-2008, 03:04 PM

I'd gain. But only you know your track record with diets. good luck!

JWRN · 08-19-2008, 03:25 PM

Well, I think I will go back and reweigh next week. I deliberately did not work out for the past 2 months just because I knew I was borderline and that there was a chance that I would have to appeal. I feel my cholesterol shooting up with all of the fried fatty food I have been eating!!

cobrien78 · 08-19-2008, 05:10 PM

Well from my referral appt. to my surgeon appt. I gained 10 lbs. I just ate A LOT more than usual switched to regular soda instead of diet, and snacked a lot. I also put on two layers of clothes and threw in change in my pockets and wore jewelry. It must have worked cause I found out today that I was approved! I was shocked and ready for denial with all the crap I've been through with dr.s at the base clinic.

It's only 6.5 lbs. I would gain it and try again! In my opinion it's definitely worth it!

JWRN · 08-19-2008, 05:16 PM

It is just strange. I guess it depends on who reviews your case. I have heard people being a little under and getting approved.
Oh, and according to the "metlife" table (which is what tricare uses), I should be weighed with my shoes on...and my Dr's office has me take mine off (the scale has a print out that they put in my chart).
I will definitely go and weigh in again next week. Just pisses me off...

azairforcewife · 08-20-2008, 01:09 AM

i was denied to for not being on meds for diabetes even though it shows my high blood suger. i'm 5'4 and 240 is that 200% over my ideal weight for a small frame? working on my appeal letter!!! wondering why everyone is getting denied!!

JWRN · 08-20-2008, 09:58 AM

I was told by my surgeon's nurse that the Tricare nurse said "I will have to have my medical director look at this" and then 12 hours later it was denied!

tomatogirl · 08-20-2008, 10:01 AM

That's a bunch of BS right there. gain the weight and try again. You're so close.

JWRN · 08-20-2008, 10:10 AM

Azair,
You need to have a doctor say that the reason they are not putting you on meds right now is because they are expecting you to have the surgery and lose weight. You are diabetic..have you had a sleep study?

azairforcewife · 08-21-2008, 02:33 AM

my surgeon has caled the medical director 3 times about my case personally and they said i need something more to be approved he is sendig me for a sleep study stat !! He also said that tricare does not know much about wls and how much better your health will be and all the statictics on diets failing ,he gave them a ear full !! do most overweight people have sleep apnea???????

JWRN · 08-21-2008, 09:23 AM

Do you snore? Are you tired during the day? Do you wake up with headaches?
Many overweight people have obstructive sleep apnea. When you sleep, the tissue in the back of the throat relaxes and obstructs the airway. This can be helped with weight loss. OSA can cause major issues in the long run.

JWRN · 08-21-2008, 10:07 AM

William C Frey1 and John Pilcher2
(1) Department of Pulmonary, Critical Care and Sleep Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA (2) Department of Pulmonary, Critical Care and Sleep Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA Published online: 01 October 2003
Background: Obesity is a well known risk factor for obstructive sleep apnea (OSA). Medical therapy is not effective for morbid obesity. Bariatric surgery is therefore a reasonable option for weight reduction for patients with clinically severe obesity. Unrecognized OSA, especially in those patients receiving abdominal surgery, has influenced perioperative morbidity and morality. The incidence of OSA for patients being evaluated for bariatric surgery has not been previously defined. Methods: 40 consecutive patients being evaluated for bariatric surgery were examined with a history, physical examination and laboratory data. Polysomnography (PSG) was conducted in all patients regardless of symptoms. Results: An obstructive sleep-related breathing disorder (OSRBD) was present in 88% of the patients. OSA was present in 29 of 41 (71%) and upper airway resistance syndrome (UARS) in 7 of 41 (17%). The mean low oxygen desaturation was 84% and continuous positive airway pressure (CPAP) was 10 cm H2O pressure. The majority of the patients were women and mean BMI was 47 kg/m2. Patient characteristics failed to predict the severity of OSRBD. Conclusions: This population of clinically severe obese patients being evaluated for bariatric surgery had an 88% incidence of an OSRBD, 71% with OSA. Appropriate therapy with CPAP perioperatively would theoretically prevent hypoxic complications associated with OSRBD. Providers should have a low threshold for ordering a PSG as part of the preoperative evaluation for bariatric surgery. Empiric CPAP at 10 cm H2O should be considered for those patients who cannot complete a PSG before surgery.

thingirl · 08-24-2008, 06:30 PM

Quote:

Originally Posted by JWRN

My surgeon and I thought for sure that I would be approved by Tricare. I have two major comorbidities.
I am 3 pounds over the low end of the Met life scale...but Tricare told me today that I am 6.5 pounds under the requirement! You have got to be kidding me!!!
So, do I try to gain the 6.5 pounds?? or just give up and go on ANOTHER diet!!

Curious??? What was your starting weight and height???