navywife

Hi,

I have an appointment this tuesday with my PCM and I'm planning on asking for a referral for Gastric Bypass. I have no problem going to balboa to have it done there.

How did you all start that conversation with your DR's? I want this so badly, I want to make sure he understands how important this is to me. How do I get that point across?

The other thing, I've been overweight my whole life. When I had my first daugher I weighed 250lbs, my 2nd daughter I was my highest at 270lbs. And over the last two years I've had a few cosmetic surgeries....and I'm not at 228 and I DON"T WANT TO WASTE all that time and money. I did question whether to have gastric bypass or cosmetic surgery and now I feel like I should have gone with the bypass. I've gained some of the weight I lost with cosmetic surgery....and I just don't know what to say to my Dr. I don't want to gain any more weight....no matter how slowly it crept on.

On Balboa's website they say

"to qualify for bariatric surgery, the patient must have a documented BMI (Body Mass Index) of 40 or greater or a BMI of 35 plus a serious health problem such as high blood pressure, asthma, diabetes, sleep apnea, or high blood cholesterol."

I am right at 40 for my BMI. I would really appreciate any help you can give me. I want to make sure I do everything right to be approved.

Heather

AirForceW1fe

You will find that Tricare is relatively easy. I did research for about 9 months before I asked for the referral. All I did was just tell my PCM I wanted a referral to a bariatric surgeon and I got it. My BMI was higher and I had 2 co morbities so it was kind of a no brainer for him to say yes. Just tell them why you want it, explain to them that you have looked up the guidelines and it appears that you qualify. It should not be difficult at all hun.

Best of luck to you on this exciting new journey.

__________________
Surgery Date- 7/14/09

Pre / Current / Goal

285 / 209 / 140


Scale aka "Satan" Whore #62

"No one said this would be easy, but boy is it worth it!!!"

poet_kelly

Why don't you just say, "I want to have weight loss surgery and I need a referral?"

Kelly

__________________
RNY 11/4/08

surgery/current/goal
270/147/130

Shetaz0028

I just looked at mine and said "ya know some people are comfy in their own skin....I might be without all this fat in there too". She laughed and RAN to get me the info.

__________________
Mad luv and respect,
Charlie

LAP/RNY 8/20/09



"Start by doing what's necessary; then do what's possible, and suddenly you are doing the impossible."
– St. Francis of Assisi

Christi

I told told mine that I was tired of being fat and tired of the declining health. She put the referral in for me that day. I too was right at 40 BMI.

Just be open and honest with your PCM. If they refuse then put in a request for a new one.

__________________
Christi


Pre-op 246 lbs
Surgery day 238 lbs
Current 204 lbs

Surgery date: September 16 2009

Battling PCOS and Hypothyroid one day at a time

terriB

I was considerably larger than you when I went to my PCP to ask for a referall. Mine had no problem with it. If they give you a problem just insist that you would like to meet with the surgeon and discuss the issue.

Balboa is not a fun place to have the surgery but they did a really good job. You just have to be really careful with any medications you need. You need to double check what they are giving you. It was not fun to be in a non-private room but I survived and you will too.

The surgeon did ask if I had ever done a 6 month supervised diet. I had and it was documented so I didn't have to wait for that. I had to do all of the classes and tests. Going through balboa meant I didn't have to get the approval of the insurance company. That was nice.

__________________
Terri B
Surgery RNY
Nov 3, 2008
Naval Medical Center San Diego
Highest/surgery/current/goal
371/340/245/150

1/3/09 - Finally out of three hundred

Waitng4

I told my PCM I was interested in hearing more about the Lap Band (what he knew about it, etc.) and started the discussion there. He wasn't a fan of me pursuing it and said he wanted to try me on appetite reduction prescription pills first. I did that for about a month and followed-up with him, the pills weren't working. He reluctanlty said he would put in the referral and did. Within a week I got a call from the surgeon's office scheduling a consult!

KarenInKali

It took me a while longer to get approved through Tricare, but I succeeded by going through Balboa. My PCM referred me to civilian surgeons, but Tricare denied me because I didn't have any of their "big" co-morbids. About a year later when my PCM put in a referral for me to go back to the civilian surgeon, I got kicked into the military system by Tricare instead. Being able to go through Balboa was the bes thing that ever happened to me.

Someone before me said that Balboa was not a "fun place to have surgery." LOL, I don't know of anyplace I would call "fun" for surgery. I had absolutely no problems with the staff or facilities, and other than my surgeon being deployed at the moment, continue to have no problems at all. I would totally recommend going through the military system if given the opportunity.

I'm 18 months out and life has never been better!

__________________
Karen

No longer Obese or Overweight - I'm Normal!
104 pounds gone forever!
Lap RNY 05/12/08
Official Scale Whore #8
ONEderland! 10/19/08
CENTURY Club 04/12/09

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There's only one "race," and that's human. All the rest is culture!

navywife

thank you all very much. It was very easy to talk to my dr. He was very supportive about gastric bypass. So he wrote the referral last tuesday. Although managed care has SAT ON IT for over a week now. only because my husband went and complained it was magically sent off to tricare for consideration.....UUUGGGHHHH!!!! IDIOTS!!!
I'll update soon......I was actually sent to UCLA and on Saturday I attended their mandatory meeting....it was great....I'm so ready to start this journey.

Army wife losing it

I have been going through things with Tri-Care since May. I JUST got my surgery date last week. It is for October 21st. My husband is in the army and we are at a small post that does not have MTF's. I am 302, BMI 41.3 with mild and I mean MILD sleep apnea. They almost wouldn't let me do this since that was the only co-morbidity I had. Just don't expect it to be overnight. Tri-Care here (in Richmond, VA and Army) I had to get, psych test, nutritionist, ABG's, pulmonary functions, chest x-ray, h pylori, thyroid, sleep test, medical necessity, weight for last 3 years. I really have been doing this since May 2009. I do have psuedo tumor cerebri which is a co-morbidity for the surgery but not for tri-care authorization. I had to get the ok from my neurologist as well. But FINALLY October 21st. I quit smoking in July and I start my 14 day liquid diet on Wednesday. Good luck to you and by no means am I trying to bring you down. But as you know, hurry up and wait. It is no different with this procedure. I do hope everything goes ok and gets approved and moves along faster for you. Good luck!