Greetings from Washington State

rebeccarox · April 9, 2011

I'm Rebecca, 37, mom of four. I've been Married for over 7 years to my soldier husband who is stationed at Fort Lewis in Washington State. I've been overweight since I was 16 years old. I did manage to lose weight twice over the years but only to regain that weight plus some. I am an active, working mom. I workout 3-5 times per week and have done so for years actually. My father's parents both died at young ages of obesity related conditions. His mother died of heart failure at age 38 and then his father the same at age 43. I never knew them. My mom is quite tiny as is most of her side of the family. I always wondered why I was so big and it wasn't until I was about 20 when I saw pictures of my father's side of the family and they are all big, obese people so I have a strong genetic component going on here. I am currently 211 and 4'10.5. I have insurance through my work which is Group Health Options which specifically excludes weight loss surgery but I also have Tricare Prime secondary with an off post PCM since we don't live on post. I'm not sure how this will work together but I have actually already emailed our insurance agent to inquire about dropping my primary coverage through work since I don't need it and only took it because it was offered at no cost to the employee.

I'm not sure if i have any comorbidities but making an appt with my PCP next week because I do believe I have symptoms of sleep apnea and the last few visits to my PCP my blood pressure has been elevated. My normal is about 95-100/50-60 and the last time i had it checked it was 138/80. However, the physician never mentioned medication or anything.

I have done some reading about the critieria for Tricare for approval. I'm not sure if I'm a small or medium build - I am leaning towards small. When they determine if you are 200 percent or not do they use the low number on the range or the high or anywhere in between? For my height, I believe at my current weight I definitely quality based on the 200 percent rule.

Does anyone have any experience with Tricare? Or specifically Triwest region? The BMI calculator online is showing 43.3.

Anyway, glad to be here starting my journey and plan on documenting it thoroughly via the blog function so that others with tricare/triwest can have access to a personal experience for reference.

Also - anyone in Western Washington??

Dave_NW · April 10, 2011

I'm Rebecca, 37, mom of four. I've been Married for over 7 years to my soldier husband who is stationed at Fort Lewis in Washington State.

Also - anyone in Western Washington??

Hi Rebecca,

Welcome to the Forums. There are a few other Washington folks currently posting here. I'm up north of Seattle, on the way to the Canadian border. I have Tricare Prime, and was banded at Swedish Hospital in Seattle about four months ago. I chose Swedish because of their location, and Dr. Ross McMahon's experience and bariatric certification. I'm very pleased with the whole clinic's performance, and with my weight loss results so far.

Depending on how you want to move forward, either by using the weight loss services at Madigan Hospital, or going off base and using a civilian location, you'll find Tricare Prime to be very specific about what they will and won't pay for. If you meet the requirements, approval is very direct. My approval took three working days to receive. Your out-of-pocket expense will also be minimal. So far, I've paid only about $100, and most of that was co-pays. Tricare paid the rest.

I'd start with a visit to your PCM, and get the referral you need to a Tricare-approved weight loss surgeon. They can then determine whether you meet all the requirements for surgery.

If you have any specific questions, just let me know. I'll be glad to help if I can.

Good luck!

Dave

MarcyLoo · April 10, 2011

Hey there! I'm in Monroe/Snohomish (northeast of Seattle). I used Northwest Weight Loss Surgery in Everett and was so happy with them!

I have a coworker who has tricare as her secondary and because her PRIMARY is refusing to cover a medication Tricare is also refusing, but if she drops her primary Tricare will. That's all I know about it though.

Welcome!!

KimPJames · April 11, 2011

Hi Rebecca - I'm in Seattle but travel to Bremerton to see my surgeon (William Neal, M.D.). I was a private-pay patient and moved through the approval process very quickly. I had the band installed earlier this year and am trying to figure out how to use it successfully. It definitely feels like it's going to be a process all on its own.