Tricare approval?

[Kayleigh 0]

I recently made the decision that I would like to go through with this surgery, but only in the process of trying to get in to see my doctor. Basically I'm 18, 5'4'' and pushing something around 245, and have been for years. I have a BMI of at least 41, and incredibly high blood pressure. I've been trying to lose the weight for 5 years give or take. I've done as much research as I possibly could but I really don't know how to get this process started. All information I have come across has said that you have to be 18 for starters to qualify but would my age set me back at all from getting approved? I plan on seeing my doctor on the 22nd of April or sometime before. About how long of a wait would it be starting from the time I see the doctor to approval and everything in between to actually getting the procedure (in your experience or otherwise)?

If anyone has any answers, thank you so much!

[Dave_NW 92]

Hi Kayleigh, and congratulations on taking charge of your weight loss.

You don't mention which type of Tricare insurance you have. There are several varieties of it. Depending on the coverages you have, there may or may not be out-of-pocket money you may have to pay. You need to find out exactly how much (if any) you'll be required to pay in order to have the surgery. The last thing you want is to get things done and end up having a big unexpected bill.

Tricare is very straightforward as an insurer, but it all starts with a referral from your primary care doctor to a weight loss surgeon. You should research weight loss surgeons in your area that accept Tricare, and find the most experienced surgeon you can. In this surgery, even though it's very specific, there is no substitute for experience. Find the right person to do not only your surgery, but also your aftercare, because you'll be needing fills and followup support. Most weight loss surgeons have programs to take you through the steps, and usually can provide all the various appointments you need.

After you have a referral to a good surgeon, you'll want to contact their office, and arrange an appointment. Many surgeons require you to attend a free weight loss seminar before they'll meet you in their offices. That way you'll know what to expect from the surgery, and you can ask the right questions.

When you meet them, the surgeon's team will tell you what they require before they'll submit the request to Tricare for you to be approved for surgery. It usually requires meeting with a psychologist, a nutritionist, and having lab work done. Other things may be required, depending on the surgeon. Tricare does not require a six month managed diet, but some surgeons do.

After you've done everything required, and the request for surgery approval has been submitted, Tricare is usually very quick to approve people. In my case, it was three work days till I was approved. Once you have your approval, the timing is up to you and your surgeon to schedule things. It can all go very fast, or may drag out, depending on how quickly you can get things done. In my case, it took a full month after the weight loss seminar before I could see the surgeon's team. But from that day till my surgery approval was only about three weeks. Others report it was even faster for them.

Search the threads here for more specific information. But before even that, I'd strongly recommend you make some phone calls. Start with your Tricare rep and/or the Tricare regional offices to see exactly what they require for your kind of insurance. Then call your primary care doctor, to see if he/she will even refer you. (You may need to see a different doctor.) Finally, start shopping for a surgeon. Your primary care doctor can refer you to that specific surgeon, if it's the best choice for you.

Wishing you great success with these steps. It sounds like a lot of work, but once you're on the pathway, it's very straightforward. Good luck!

Dave

[L12 13]

If you have Tricare Standard (or Reserve Select), you do NOT need a referral to see a covered weight loss surgeon, unless that particular surgeon requests one. You DO need a referral if you have Tricare Prime and have a PCM. When I was first seeking a surgeon, I called around and looked online, which was a rather long and tedious process. Then I called Tricare, and the customer service agent was very helpful in giving me names and contact info of covered surgeons in my area--ones I had not found in my own search.

[Kayleigh 0]

I am sorry - I left out the fact that I do have Tricare Prime. I have found the name of a surgeon off the base who has done the procedure for people who have gone through Tricare. Some people have suggested that I may not need to leave the base hospital for this, but I'll see when I get in to see my doctor soon. I do hope that my doctor may think it's a good option for me since I trust her and her opinion. Thank you both for your help!

[Dave_NW 92]

I am sorry - I left out the fact that I do have Tricare Prime. I have found the name of a surgeon off the base who has done the procedure for people who have gone through Tricare. Some people have suggested that I may not need to leave the base hospital for this, but I'll see when I get in to see my doctor soon. I do hope that my doctor may think it's a good option for me since I trust her and her opinion. Thank you both for your help!

Two things to look into if you're comparing having the surgery at a base hospital or with a civilian surgeon:

1. Who is going to perform the actual surgery? (Many military hospitals have Interns, not fully-certified bariatric doctors.) How many surgeries has this intern/doctor/surgeon actually performed? What is his/her success rate? How long have they been performing the surgery? And if military doctors, are they up for transfer anytime in the next year? (The last thing you need is to lose your doctor in the middle of your follow-up aftercare because they got transferred. You want continuity in aftercare.) You should ask who will be doing your fills, too.

2. How long is the wait time for surgery? Here in Washington, there is a lengthy waiting list at the military hospital, and a person can wait months to get their surgery. A civilian surgeon may get you in much sooner than that. You'll pay the same, regardless of where your surgery is handled.

Good luck!

Dave

[Kayleigh 0]

Thank you, Dave. I'm sure I'll bring all of this up with my doctor as soon as I can get in to see her. I do plan on moving across country (from Alaska to Texas) but I am now planning this move around the surgery if the surgery becomes something that I will be doing. If I do get the surgery here then I will put the move off for a while, if not then I'll see about finding a doctor down there. Thank you for all of your helpful info, Dave!

Kayleigh

[GlitterG 1]

Where in Texas will you be moving to? I am in Killeen (Fort Hood) and the process really only took about 2 months beginning to end.

[Kayleigh 0]

Where in Texas will you be moving to? I am in Killeen (Fort Hood) and the process really only took about 2 months beginning to end.

Around San Antonio. My two friends are "taking me in".

[GlitterG 1]

Around San Antonio. My two friends are "taking me in".

You will love San Antonio! I have two grown daughters who live there. Not to mention some of the best military hospitals.

[Kayleigh 0]

You will love San Antonio! I have two grown daughters who live there. Not to mention some of the best military hospitals.

Yeah, I haven't been there since 2003. It's the nicer part of Texas, that's all I remember haha. I'll just be glad to get away from Alaska, haha. (: Thanks for the help!

[Dave_NW 92]

Around San Antonio. My two friends are "taking me in".

Kayleigh, make sure your Tricare Prime coverage will follow you when you move. Not sure how it is these days, but it used to be that medical coverage ended when a dependent moved out of the service member's house. You may want to delay moving to Texas till you've had things done in Alaska.

Dave

[Kayleigh 0]

Kayleigh, make sure your Tricare Prime coverage will follow you when you move. Not sure how it is these days, but it used to be that medical coverage ended when a dependent moved out of the service member's house. You may want to delay moving to Texas till you've had things done in Alaska.

Dave

Great point! Thanks, I have made an appointment for April 20th for consulting my doctor about this, hopefully I can get the ball rolling with all of this soon. I'm definitely delaying this until I know whether or not I can get the surgery here. If not then I'll go ahead with the move but contact Tricare Prime about if my coverage will follow me. I have been told that I can stay under my father's insurance until I'm 26 but we're not sure if that means I have to be a student or not. I will definitely contact Tricare soon!