Tricare- will I qualify?

[BandedJenny 0]

Hi, I wondering if anyone knows if Tricare would qualify me for a lapband? I'm 5'3'' and about 234 pounds. I do have very large breast that are causing back pains and bad rashes. Also have carpel tunnel. Thanks.

I'm really trying to get qualified as I've had weight issues my entire life but after having my twins, it got worst.

[lovemysgt 4]

I have tricare and they pay for it if you have prime. i am not sure about the lower ones. what is your bmi do you know? i got approved fast.

[Shay7997 0]

I was 5' 3" and had a BMI of 39 at a weight of 220. I also had two co-morbidities. I was completely covered under tricare prime. They were amazing about the whole thing.

[macie1 0]

Do you have tricare prime, standard. Are you trying to banded on base or off. If you go to the tricare website they have the requirments listed. Since I'm doing mine on base I never had to worry about the insurance.

[lovemysgt 4]

im off post and had no problem and i have prime

[tylee72198 10]

im off post and had no problem and i have prime

Samsies...I was approved within 24 hours of the paperwork being submitted.

[tylee72198 10]

Tricares requirements

Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints

Is 200 percent or more over ideal weight for height and bone structure

[BandedJenny 0]

My BMI is between 39-40 depending on my weight that day. That said, I'm not too sure if I have co-morbidities. I don't have diabetes or hypertension. Like I mentioned before, I do have large breast causing bad back pain and rashes. Also have carpal tunnel. I have a civilian PCM but do live near a large MTF (San Diego).

[Shay7997 0]

Just talk to your civilian PCM. I had a civilian and that made it so much easier than trying to deal with the base.

At under 40 BMI, you need 2 co-morbidities. At 40 or over, no co-morbidities will be required.

I researched the doctors in my area to exhaustion and picked the one I wanted. I wanted to make sure I got a doctor who did lap band on a regular basis and was going to be there for me when I needed him.

[MellieW 0]

If you are over 200% of your ideal weight you aren't required to have 2 co-morbidities. But anything under 200% requires co-morbidities, and unfortunately large breasts nor carpal tunnel qualify as co-morbidites.

That being said we are retired military with Prime and I was approved within 48 hours. =)

Edited September 11, 2010 by MellieW

[missgypsy 1]

I'm tricare prime and my pcm is on post but i had my surgery off post. my bmi was low at lil over 36. i have heard and read all the horror stories about tricare and being approved. i had to fight to get my surgery because my local tricare off kept saying no and wouldn't let me have a second opinion. needless to say i went over heads and contacted the regional director and i got my second opinion. which determined i qualified to have the surgery. i would suggest that you go in and talk to your pcm. according to what you put as your height and weight your bmi is 41.1 so you wouldn't need any co-morbidities. they can lead you in the right direction. are you looking to have the surgery on or off post?

[Kierstyun2010 0]

Hi JD2010! I am a Tricare Prime beneficiary and got accepted after 3 times of re-submitting my paper work. It took 4-5 months all together to get accepted. Just DO NOT give up, it takes time. I do have one piece of advice don't let the surgeon scheduler do it all. Call Tricare yourself and make sure they have everything you need etc. I am only 18 years old with a BMI of 40 and they accepted me so I'm sure you will be as well.

I went to a seminar in May of 2010 and here it is September and I'll be banded this month on the 23rd.

Tricare sometimes is really fast and isn't other times. Just do not give up!

Hope all goes well :smile:

[BandedJenny 0]

Thank you all for your responses. I go in on Tuesday to see my PCM. I know she'll give me a referral and hopefully things go smoothly from there. If not, I won't give up and keep trying. I don't know where I'll have it done when I qualify. I'm in San Diego. Does anyone have any recommendations?

[emeraldinthesky 0]

I was worried too!!! I have a BMI of 38 and weigh 234 and i listed having asthma,pre hypertension,pre diabetic, pain in my knees and one kidney. None of those really qualify as a co morbidity, but I guess it's in how you word it. I'm lucky enough to have send in my documents to Tricare Prime and get my approval the next day! Hopefully you have a PCM thats willing to work with you as well as mine did. Good Luck!!!!