Tricare Prime South BMI requirements?

[wesmommy 2]

So I really want this sugery and i have tricare prime, I have been reading that they are no longer requiring 100 lb rule that they are now using a bmi factor? what is the range that you would need to be in? I am 5ft and like 1/2 an inch that i will completely slouch down for if it helps and i seem to go between 199-195 (for the last 5 mos) GRR that puts me just under the 40 bmi I have no problem gaining a few lbs to get the band! but do i need the co factors too? I had high blood pressure for years and about 2 years ago i stoped taking my meds for it when i was pregnant and havent been put back on it would this count ?

thanks any and all input would help

[MustangMama 2]

I haven't heard anything about Tricare changing their policy. I was just banded on July 26th and the policy was still the standard one. The best thing I can suggest is call Tricare. They can tell you what they require.

[MelindaH 3]

Hi,

Like mustang mama, I suggest that you call Tricare. But I have one concern--are you monitoring your blood pressure at home? If it is running high, please see your doctor. Regardless of insurance concerns this needs to be addressed before any surgery. You may already be doing this, so please forgive me for "butting in" but high blood pressure is always a red flag if not treated. I wish you all the best as you meet with your surgery team. Keep us posted and drop in often.

Melinda

[AZArmyWife36 0]

Great news! Tricare has new rule in manuals. New rule should be in system at the end of the month. You should be approved if you have a BMI of 40 or 35 - 40 with one co-morbidity. Not too sure what else is required. Keep your eye on it! Good Luck!

[formykids2 4]

with the new rule you do have to prove you have tried and been unsuccessful with weight loss with medical intervention. That being said, it could be that you have done weight watchers or any other diet w/ or without meds also but you HAVE to have monthly visits so the pcm can monitor your weight. The comorbidities have changed from the previous policy too!