Questions about Tricare South

[QueenWood 0]

Hello everyone! I attended a Lapband information session last week and I left out sure that I want to do it but unsure about the insurance portion. I am 5'8" 280lbs. I have a BMI of 42.5 so I know that I qualify in that sense. However, I don't have any comorbidities. I am actually relatively healthy considering my weight lol. I do suffer from pain on my weight bearing joints from time to tiime, and I have had sciatica since my first pregnancy so I do suffer from pain in my back and lower extremities. I am being treated for it with pain medication and physical therapy. What I want to know is if I still have a chance of being approved for surgery without any comorbidities. Also, which is better.....Prime or Standard? Currently I have Tricare Prime but we are PCSing in a few weeks (Ft. Stewart to Ft. Gordon, so I'll still be in the same region) and I wanted to know which one is easier to get approval on. My other question is are there out of pocket expenses with Tricare and if so, are they cheaper with Prime or Standard. I have called Tricare, but all they do is rattle off exactly what I had already found on the website. Also, any other information anyone may have on Tricare will be much appreciated. I just want to have my stuff together so that I have a better chance of getting approved the first time around lol.

[Stacey H 4]

Ah! I can help with this! Haha. I'm also 5'8, and I started my journey at 283. You will absolutely be approved with Tricare South.. it took them just over two weeks to approve me. All I did was visit my general practitioner and speak with him about it, then he sent me to a consultation with the surgeon in my area. After talking to the surgeon, the secretaries in his office took care of everything for me. I got the surgery about a month & a half after I visited my general practitioner for the first time. I didn't have any comorbidities either, but my surgeon still had me do a sleep apnea study and a few other things just to be sure. And I'd say Standard is better... with Prime, you have a copay with the office visits, but I've got Standard (free visits!) and all the ladies in my surgeon's office agree that Standard is the better option. I think I've answered all the questions you've asked.. if not, I'll be happy to answer anything else I can! Good luck!!

[QueenWood 0]

Awesome!! Thank you so much, u did answer all my questions and now I feel much more confident in my decision to go through with it. When I get to my new duty station I will be switching to standard and getting in with my new doc asap. Thanks again!

[Mimilou2004 13]

I think you may be mistaken....I have Standard and have a huge co pay always but the ppl with prime had no co pay for anything. I was and still am out of pocket for every procedure...I would have switched to prime long ago had I been thinking straught.

Dave NW weigh in.

Mimi

[Short and Chunky 230]

I have Tricare Prime South and my only out of pocket was about $300. I had to pay for the dietician visit, a co-pay (paperwork charges) to the surgeon and $50 toward the mental health eval. I went to my primary first and she recommened I have the sugery (I asked her about it) - I had slightly elevated BP and a BMI of 42, no other issues. I went through all the "steps" and was approved on the first go-round (about 2 weeks after papers were submitted. I am doing great loosing a ton of weight and all my follow-up visits are totally covered (no co-pay). Good luck Melinda (48 punds skinner and counting !!!!)

[bowlerchick300x2 0]

Tricare prime does NOT have copays

[DawnH 9]

Hello everyone! I attended a Lapband information session last week and I left out sure that I want to do it but unsure about the insurance portion. I am 5'8" 280lbs. I have a BMI of 42.5 so I know that I qualify in that sense. However, I don't have any comorbidities. I am actually relatively healthy considering my weight lol. I do suffer from pain on my weight bearing joints from time to tiime, and I have had sciatica since my first pregnancy so I do suffer from pain in my back and lower extremities. I am being treated for it with pain medication and physical therapy. What I want to know is if I still have a chance of being approved for surgery without any comorbidities. Also, which is better.....Prime or Standard? Currently I have Tricare Prime but we are PCSing in a few weeks (Ft. Stewart to Ft. Gordon, so I'll still be in the same region) and I wanted to know which one is easier to get approval on. My other question is are there out of pocket expenses with Tricare and if so, are they cheaper with Prime or Standard. I have called Tricare, but all they do is rattle off exactly what I had already found on the website. Also, any other information anyone may have on Tricare will be much appreciated. I just want to have my stuff together so that I have a better chance of getting approved the first time around lol.

I am in a different region than you, Tricare West, but when I went to my PCM they gave me a referral and I have no comorbidities but a BMI of 42. They did refer me only to the Naval medical center here in SD because they had openings at their bariatric clinic but she said they do refer out to civilian if there are no openings. I do have a friend that had to get referred out because of no openings at the medical center and she had no out of pocket expenses. All my appts I had to have at civilian drs. such as the sleep study and psych eval were all approved no problem. Good luck!

[DawnH 9]

Awesome!! Thank you so much, u did answer all my questions and now I feel much more confident in my decision to go through with it. When I get to my new duty station I will be switching to standard and getting in with my new doc asap. Thanks again!

There are co-pays with Standard and NOT with Prime.

[QueenWood 0]

Thanks everyone for your responses. I will keep all of this in mind for sometime next year because I found out I am pregnant last week lol. So the surgery will have to wait until after baby

[drowsyrn 0]

Congratulations!

[QueenWood 0]

Thank you!

[Mimilou2004 13]

DO NOT switch to Standard since you are having a baby and want the band....you will be sorry if you do.

Congratulations on the baby.

Mimi