There have GOT to be some people like I am that want to ask these questions.
What if your BMI is above 50, you have been above 300 lbs for well over 15 years, have had a gall bladder removed, an MRI for a knee problem, diagnosed with high blood pressure just a year ago, have been on lots of diets but none "supervised" and you have NOT got a lot of doctor info to give to the insurance company as you haven't seen a doctor a lot (for me it was a combination of the problems I had with doctors when I would go to them, ie the first dr I went to for pains that turned out to be gall bladder trouble told me to lose weight and I would feel better and a couple months later I had to have emergency surgery and was told if I had waited another few days would probably have died. I also have a husband who is retired military and at the time we only had Champus available to us, the doctors where I lived wouldn't take me on as a patient without CASH so I didn't go.) Is it still feasible to get my insurer, Tricare Prime to ok surgery? I am trying to find out from Tricare whether they will do lap band as I am more than a little leery of bypass surgery.
How can I say this without offending as it is directed just at me and no one else, ok? My dd tried to talk me into this two years ago and I resisted because for me, my mind keeps telling me "you are giving up too easily and should continue to diet." Problem is, I did lose 100 lbs about 18 months ago and have now gained back around 60 lbs of the loss. It wasn't that hard and I did it DOING exercises. I am not saying my food choices were the best, but I was not like on an 18 month binge or anything. I just keep stalling taking this any farther because I keep trying to convince myself I am taking the easy way out and I should still continue to work at it. Does anyone understand what I am saying and have felt the same way?
As for the kind of candidate I would be, I feel I am an excellent candidate as I have the right psychological attitude, do NOT want this just to look better but because of health, have no problem with exercise as I exercise 6 days a week and 7 in the summer when the pool is open and can adapt to behavior modifications. I have a good self image and do not mix it up with body image either.
Thanks for any input you have. I appreciate more than I can say.
I've been morbidly obese for the past 10 years. I hovered around the 300 mark and a BMI of nearly 50 for about 4 years. I topped 310 and a BMI of 50 and sat there for the better part of a year.
I kept putting off any talk of surgical assistance for weight loss for about 8 years.
It wasn't until I heard about adjustable gastric banding that I even remotely considered surgery. And then it was to read about it and say, "Well if I ever get that desperate that's what I'll do.
It wasn't until my scale stopped weighing me, followed shortly by one of my best friends having Duodenal Switch surgery that I really started to realize that for all my bravado and for all my big talk about "doing it myself" ... I wasn't getting any younger or any thinner.
That was October of last year. In January of this year I had Lap-Band surgery. It is the best thing I have done for myself in a very long time.
I honestly believe that my long journey to this point is part of what helped me be truly ready to do what I need to do to work this surgical tool for all it is worth.
It can't hurt to talk to someone at your insurance company to see what they will or won't cover. I think (but I am not positive so please don't take this as gospel) that I have read on other boards about Tricare Prime patients be approved for Lap-Band surgery. Take your time and find out what you can about the surgery, your insurer and what you need to do for approval.
At the very least a little knowledge never hurt anyone!
oh my, gma! what a mouthful you said! i agree with veggymom- ya gotta try. i KNOW you've tried. i've SEEN you try. i've SEEN you work at this. in fact, i can't help but wonder if showing your doc - and maybe your insurance company - some of your posts from around here might help.
bottom line: no matter what you decide, you owe it to yourself to look into it, to ask the questions, to find out what you need to know in order to make the right decision for YOU.
remember, darlin, at this point, IT'S ALL ABOUT YOU. and no one else. it's not about your husband, or your kids, or anyone else. it's about what's right for you. and you are more than welcome to hang out here and ask all the questions you want.!!!
Thanks guys! I seem to be a little more discouraged than I used to be. If you know me and have read my posts over the years than you KNOW I am not a person that gives up on myself, nor am I one of the poor souls that thinks she deserves what she gets. I am also one who admits that it wasn't a "spider bite" (sorry, reference to a Dr Phil show) that made me fat.
I am still in the vacillating stage with this, but any help you can give me I certainly DO appreciate.
Faye...
I don't normally post here, (south beach is where I post). Not following any diet right now. Just watching my choices. I have decided to change my insurance from Tricare Standard to Tricare Prime just to have this WLS done. Standard is not excepted by most doctors here. I have read in another site that Prime pays for 100%, and tummy tuck if real bad excess skin after goal is reached. I have already called them and they at this time do not pay for lap band. They did a few years back and stopped because of the research. They said they may again cover lap band in the future. I understand now from their site, they are redoing writing some of the what's covered and what's not. I am waiting for the new rates to go into effect and then paying and changing and going forward. I don't want to pay and then in a few months have to pay the deductible again at the higher rate.
I too am still doing research to make sure I want to do this.
Good luck and if you find any good sites please let me know. I will pm you with one I found. Don't think I give it here.
Chipper
I am still in the vacillating stage with this, but any help you can give me I certainly DO appreciate.
Faye,
I spent a lot of time in the vacillating stage. I never blamed anyone else for my weight problems either - I knew where the blame lay and it was squarely on my own shoulders. Which isn't to say that I didn't recognise some of the outside factors that contributed, but I knew the ultimately the responsibility was mine.
I hated the idea of having WLS because to me (and again this is just about me and not anyone else) I meant that I was giving up on myself and admitting that something was beyond my control. I am, if nothing else, a control freak. Admitting to anyone, let alone myself, that I was out of control ... that there was something I couldn't do on my own ... took more courage than I had.
So I vacillated for years. Or as I am beginning to realize now, I wasted years of my life being morbidly obese when I could have been doing something really constructive.
The most important thing you can do for yourself is gather as much information as you can about all of the options available to you. From surgical options to Weight Watchers to Jenny Craig or prescription medications. The more you know the more comfortable you'll be with any decision you make.
And of course if there is anything you would like to know about my experiences with the Lap-Band and my looong road to surgery I'm a post, private message or email away.
i know what you mean, veggy. i also spent a lot of time vacillating and researching. i thought that if only i could get up and move, i'd be able to lose the weight. unfortunately, or fortunately [still not sure about that!] it didn't happen. i viewed surgery as mutilation and unnatural and i always believed that i could do this myself.
and looking at what i ate - although certainly not perfect - it wasn't too bad. it really wasn't enough to justify my size [estimated calories about 2000-2500 - enough to make me overweight, but 500 pounds? dieticians said that i'd need at least 4000 calories to reach and maintain that weight, and there was no way that i was anywhere near eating that much!]
when i realized - deep down inside - that WLS offered me the best hope of losing the weight AND KEEPING IT OFF, that was the turning point.
everyone makes this decision - to do it or not - in their own time and in their own way. there's no right or wrong answer, just the decision about what's right for YOU.
I have sent away this morning for my military medical record, my hospital record for my gall bladder surgery and the dr office where I used to live and has a couple of things in it in case I ever decide to do this.
I just got a response back from Tricare and they DO NOT do the lap band because: "lap banding is considered unproven and cannot be authorized."
So, I am not sure I am going to go forward at this time. I am just not comfortable with the bypass surgery. I guess I will just try a little bit harder doing what I am doing and get this weight off.
I don't have all the issues that you do... but I do have Tricare Prime, my Dh is USAF/AD. They do NOT pay for Lap bands. They ONLY pay for the RNY procedure which is what I ended up having. The reason being is that the results (In their opinion, not mine) is that the cost of it isn't that much less than the RNY, and the results are slower to achieve. Does that make sense?? My surgeon does both procedures and said with RNY you'll usually loose most of the weight in about 12-18 months. Where as with they Lap Band it can take up to 3 years. That means Tricare will still be paying out for your meds as you lose weight slower AND they will have paid for the surgery. Usually after the RNY you don't need most medications (insulin, Blood pressure, cholestrol, ect) and that saves THEM money. I hope you find all the information you need. Good Luck,
Sharmel
What if?????
