Tricare Prime (west Region) New Policy As Of 10-5-11

[MrsMoretti 0]

Hi everyone I have tricare prime west region iv been through the whole process already once before and i got denied this was before they just changed there policy as of 10-5-11 where now they arnt using the 100lb over weight or 200% rule.... they are now going by a bmi of 40 + without a co morb or 35-39.9 with a co morb ..... I am about a 40 with no DOCUMENTED co morbs but I also have heard now they are making you do a medically documented weightloss program weight watchers or jenny craig etc. I heard it was a 6 month program that had to be documented but when i looked in there policy they dont state a time frame or 3 or 6 months .... im just curious if anyone has been approved without having to do this 6 month diet program .... i have documents from my dr. stating i did weight watchers with no sucess but also it wasnt for 6 months maybe 3 or 4..... so just curious is any of you have been where im at and if u still got approved I got to my see my surgery dr tomorrow for my last final weigh in before they can submit my paperwork again im really hoping to get approved ..... please please please let me know people..... thanks : ) wish me luck

shayna

[loretta\ Baconton Georgia 10]

I have bcbsi and they MAKE you have 6 conseutive months of weight loss program, non surgical and it has to have alot of components with it.. so good luck.

[MrsMoretti 0]

greatttt!!

[PHANY 0]

mrs moretti IM IN THW WEST SIDE TO AT,FORT IRWIN DID U EVER FIND OUT IF WE HAVE TO DO THE 6MON DIET PLAN I MEET MY SERGEON MARCH 8 2012

[Littleamberofky 0]

I am at NAS fallon (navy). I haven't sent in my papers yet, I still have to do the nutritional evaluation but I lost it when they tried to tell me I needed to go back on weight watchers so they could document it. I called tricare and the guy said that it doesn't say specifically a time frame to do it. I printed the policy, had Weight watchers send me a copy from where I did it 3 months in the past on my own with little progress and my doctor wrote it in my medical records so it's documented.

Like I said, I haven't been approved yet but I don't see any reason why I won't be because I have tried and it isn't my fault that my doctors suck and wouldn't help me after I expressed my desire to lose weight. Since they wouldn't help I did it on my own and that should be enough to get me past the attempts to lose weight prior to requesting surgery. The surgeon that would be doing my surgery requires you to lose a percent of your body weight before surgery as well just to further prove you are serious about this.

You should also be sure to tell them about any gym memberships you have had, if you did slim fast or just a general low calorie diet or something no as marketed as weight watchers or jenny craig. Everything you've ever done to lose weight should be mentioned to your doctor.

[Ric 89]

I am Retired From Marine Corps in Yuma AZ and had no problem with Triwest! In fact I was approved 1st time twice before I was banded. I had to do a sleep study and Upper GI endoscopy as well as a nutrition class. I did not have a six month thing to deal with just a refferal from my Primary Doc that happens to be on base also!

[Ric 89]

I am Retired From Marine Corps in Yuma AZ and had no problem with Triwest! In fact I was approved 1st time twice before I was banded. I had to do a sleep study and Upper GI endoscopy as well as a nutrition class. I did not have a six month thing to deal with just a refferal from my Primary Doc that happens to be on base also!

[PHANY 0]

HI IM IN THE MIDDLE OF THE WHOLE PROCESS IVE DOBE BLOOD LAB WORK AND MEET MY SURGEON MARCH 8, 2012 IS THE 6MONTH DIET PLAN REQUIRED?

[PHANY 0]

I AM AT FORT IRWIN BASE PLEASE LET ME KNOW

[PHANY 0]

SOOO I HAVE TRICARE,PRIME WEST IM AT FORT IRWIN CA AND I FOUND OUT YEEEEEEEEES,U NEED SOME TYPE OD DOCUMENTATION STATING YOUVE ATTEMPTED DIETING WITH,OUT ANY A 6MONTH DIET PLAN IS REQUIIRED SUUUUUCKS I KNOOOW I DONT HAVE 6M OF BACK UP PAPER WORK STATING IVE TRIED BUT I HAVE SOOOOOME SOOO IM GOING TO WAIT AND SEE IF MY INS WILL COVER THE PROCEDURE IF NOT THEN IM GOING TO HAVE TO DO MOOOORE DIIIIIIIETS YAY ME FML

[hedder14 59]

I just had surgery on the 8th of Feb and I have Tricare Prime North.. I was required to have 6 months of classes with no missed classes, if missed you have to start over.. I had to have sleep study done, a pulminary ( sp ) function text, labs, ekg, exam by my primary care from my dr. and a physic eval.. Once everything was done it took them 2 wks to ok the surgery

[PHANY 0]

HMMMM WIERD I HAVE TRICARE PRIME WEST HOPFULLY WITH THE PAPERWORK I HAVE OF ATTEMPTED WEIGHT LOSS I CAN GET SURGERY I DONT HAVE THEM FROM 6MONTHS STRAIGHT BACK TO BACK THO

[mufasas-mom 170]

you will probably need to complete the 6 months of nutrition/dietician visits prior to getting approved. have you phone the insurance company on the back of your insurance card? and ask for the bariatric person to assist you with your questions? each insurance is so different pending on location/company that it's always best to call and have your questions written down so you don't miss anything.

good luck..

[new beginnings03 9]

You will need to complete this 6 months with your Primary care Dr. You will need to go in every month for 6 months and have the document your visit weight etc. I too have tri care prime and I am in Nv. Hope all works out for u