Tricare...friend or foe?

[d1marie 0]

Hello, Im just beginning the process of hopfully being approved for lapband. I have Tricare prime, north region. I'm 5'7", 255 pounds. I don't have any serious co-morbs, but I have elevated cholesterol and blood sugar. I have a horrible family history of diabetes and I am the only person in my family who isn't taking insulin shots...yet. I was just seen at the chiropractors office who mentioned that he believes I have arthritis in my lumbar spine and causing terrible back and leg pain. My question to you all is this...what are the chances of me being approved based on this history? Also, how in the heck do you figure 200% of your ideal body weight?

I'm also taking heartburn medication as well.

Thanks friends!

Edited July 23, 2010 by d1marie

[tylee72198 10]

I have Tricare Prime South, and I was approved within 1 day of the surgeons submitting it. I was actually shocked I got approval that fast. I have high blood pressure and am pre-diabetic.

From what I could figure for the 200%, you take the ideal weight and multiply it by 2. That should give you the 200% number. If you are over that, then you are over 200%.

[sockmonkey 0]

I am in Triwest region and they are really prompt. For your ideal weight based on your height used by Tricare, go to the MetLife BMI chart located here:

Height & Weight Tables

Then use the weight indicated as the lower end of medium build. This is the number Tricare used when calculating my eligibility. Tricare requires 100 lbs. overweight with 1 comorbidity OR 200% of ideal body weight.

To share my experience with the approval process, I was just at 100 lbs. over with 1 comorbidity (sleep apnea). I was denied. They said that they would review my case if I could provide a copy of my sleep study. My weight loss surgeon handled this for me. I received a call about 2 weeks later saying that I was approved! Hope this helps!

[sockmonkey 0]

Oh, and 1 more thing. Tricare is very firm about what constitutes a comorbidity. Like I said before, they would not just trust that I have sleep apnea, or even review my claims for all of my sleep studies and sleep supplies that they've been paying for for several years, they wanted actual documented proof. You might have to jump through a few hoops to get a comorbidity, or it might be worth it to just eat a big lunch and wear heavy shoes to your appt.

[lntwalters 0]

I had borderline diabetes with a family history. Tricare was great. I was approved within a day. I did have to call to check. My bmi was 42, my weight for my height was right at the approval mark and I was told not to lose any weight till surgery or I may not be approved. I had the surgery within 2 weeks! :smile: My post-op and fills were not a problem either. From your history I do think you will be approved. Good luck! :smile2: