Tricare - requirements / nutritionist

[Taraj2004 0]

Hey -

I just spent an hour reading through all the tricare posts so i'm hoping some one can answer this.

Does tricare make you see a nutritionist for 6 months?

are there any requirements that i should know about?

· 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

· Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown)

I am 5'3 221 bmi of 39, fertility issue, joint pain, several failed attempt at weight loss. A friend of mine is getting LAP-BAND® and she told me its a long battle that she has been dealing with it for a year, she then said you have to have 6 months of documented weith loss / nutritionist so i'm just trying to see if anyone else has had to deal with that?

Edited October 2, 2010 by Taraj2004

[Dave_NW 92]

I have Tricare Prime. I'm told they do not require doing a doctor-managed weight loss program. My surgeon's office says they're one of the easiest insurance carriers to get surgery approval from, as long as you meet the minimum requirements. (Excess weight, BMI, other comorbidities.)

I met with my surgeon's team last week for the first time, in a "marathon" all-on-the-same-day appointment. There are still a couple more appointments to meet this month, but I'm told I should expect to have surgery next month. That would make it less than four months from first phone call to surgery day.

Hope this helps,

Dave

[Taraj2004 0]

Thank you! you really answered my questions! I'm going to the dr tuesday and i'm gonna push for lap band I've had enough!

[Rsilversea 2]

Your best bet is to contact your Tricare repesentative. I didn't have to go through any monitored weight loss before surgery but I did have problems with Tricare stating I wasn't fat enough (or rather, I didn't meet their requirements). Eventually, my representative called them and read them their policy stating that I was indeed covered. Please contact your representative. They will know Tricare policy best and can help you.

[lauragshsu 6]

I'm with Dave. I went to see my PCM Nov 25 and got a referral immediately (of course, my BMI was 47). I had no comorbidities, but I have PCOS (which sometimes they count), plus a family history of high blood pressure, high cholesterol and diabetes. I didn't have to see a nutritionist nor did I have a Dr followed diet of any kind. I was banded less than 4 months after that initial PCM visit. It only took that long because of tricare insisting I see one of their drs for the psych eval. I could have been banded at the beginning of January if it weren't for that.

My surgeon (and his whole team) told me tricare is one of the easiest insurances to both work with and to get approval from.

[tylee72198 10]

Met with my surgeon on June 17, and I was banded on August 2. I was amazed at how fast the process went, since I met the requirements.

[krissy1 0]

I have tri-care prime and I didnt have to have a six month diet plan. Didnt have to many issues with them and was approved within a week of submiting. You do need to be 100lbs overweight and they measure what your frame should be with your elbow. so i'm a medium frame and my weight had to be 225lbs and small it would have been 208.

[Dave_NW 92]

Tara, just a follow-up to your questions:

I'm now approved for surgery. Here's the schedule:

Referral from PCM to WLS Surgeon 19-Aug-10

Attended WLS Seminar at Surgeon's Clinic 25-Aug-10

Office Consult - Surgeon/Staff 29-Sep-10

Lab Work 1-Oct-10

Endoscopy 14-Oct-10

Surgery Request sent to Insurance 15-Oct-10

Surgery Approval from Insurance 20-Oct-10

Office Consult/Sign Surgery Consent forms 16-Nov-10

Surgery Scheduled 6-Dec-10

This process could have been done faster, but my surgeon and I both have scheduling conflicts. We ended up postponing surgery for me from the first week of November to the 6th of December.

So the answer to your initial question is No, Tricare does not require you to see a nutritionist or go on a managed weight loss program.

Dave

[Kimmers2011 0]

Newbie to the whole process..thanks to everyone for their words of wisdom. I have finally come to terms with my decision to go forward and pursue the LAP-BAND® surgery. So, my questions are

1. Any one with Tricare Prime Remote? We are at least 2 hrs from the nearest MTF.

2. Does having emergency gall bladder removal a co morbidity?

Thanks again!