Tricare Prime--Question

[☠carolinagirl☠ 18,721]

After discussing with Tricare (prime via North region I have)..there is no 6 month wait. But my clinic

said if they send all my paperwork for approval (after all my pre-ops are done) that if I do not have a 6 month history in my dr's paperwork, sometimes the request for surgery is denied.

Those who have had surgery w/Tricare (prime), did you go to the doctor every month for 6 months in a row prior to wanting to do the lap band? I for one only went to the doctor when I was sick or needed refills on my motrin.

Appreciate any responses at all.

Tricare has told me to do all my requirements and have the clinic submit for approval (w/o the 6 month period). By the time I do get all my items done, it will be 2 months since I started the PCD visits.

thoughts?

suggestions?

TY in advance.

[Ready2BFit 33]

My husband is on Tricare Standard and is required to do the six months weight loss seminars but there was no record with his PCP. However, with me doing a WLS for 1 year (2009 to 2010) I was approved immediately by Tricare Standard South. Even thought I have been approved by Tricare, I am still awaiting for the word from my surgeon. Trust me, I want this to hurry as much as possible but I am going to just be patient because now I am trying to prepare my mind, body and soul for this new journey I am about to embark upon in my life.

[Ric 89]

That is right! I had to do a sleep study and a EndoScopy to asure that I did have Sleep Apnea and Gird! and then was approved 1st time! But I was also over 100lbs over weight.

[armymom2012 51]

_{I had my surgery January 25. I am also on Tricare Prime (North). I did not have to show 6 months proof of anything where I had attempted to lose weight prior to surgery .}

_{The only requirement they have is a weight requirement or atleast 2 co-morbilities that would cause health concerns due to you weight, which is why I ended up getting approved in the first place.}

_{Although, I did have to fill out the application that the Bariatric Office gave me, asking all kinds of questions about what I had done to lose weight prior to seeking surgery options, pills etc. I was not asked to show receipts for Weight Watchers or Gym memberships etc. My Primary Care doctor was asked to send Tricare a referal letter, explaining my health issues caused by my weight and she happened to mention how long I have been a patient of hers. That was it. Other than that, I was asked to get special blood work done and an EKG prior to the surgery, because of health concerns, but after all of that was done, I was approved for surgery and was put on a diet a few weeks prior to the surgery date. The other thing that I was told was, that you would have to also get is a Psychological Evaluation prior to approval. Make sure that you contact Tricare and get a name of the person you talk to if they say yes to that question and follow their instructions clearly, because I am still arguing for that bill to get paid now. Honestly I think it was the doctors office making a filing mistake. But other than that, the whole process starting from the 1st meeting with Lap Band seminar to the surgery took about 6 months total. Alot of that has to due to how long it takes your primary to send a referal for all the tests and the Surgeon to set up your appts with them to acept you and then to do the surgery.}

_{Good Luck to you:)}

[waitingpatiently 250]

I have Tricare standard (North). If I look in the benefits section online, it said I had to complete a six month diet. But when I went to the doctor seminar, they said I didn't. I didn't want to take a chance of going through the process and getting to approval time for them (insurance) to say "now you need a 6 month diet". so i went ahead and saw my GP doctor monthly as I waited on my first appointment with the surgeon, through all the testing and dietian, psych appointments....that way when it was submitted for approval I already had complted 4 months of the diet. Worst case senerio I would be delayed 2 months. All this being said, tricare didn't require it and the doctors office was actually correct. I was worried because I am only 36 BMI but I do have 2 comorbidities.----I would suggest you call the insurance person at the surgeons office. They work with the insurance companies so much, they usually know what is expected.

[Regnu 9]

I have Tricare South, did not have to show that I've been trying to loose weight for the last six months. I did get a letter from my PC though that stated I had tried various weight loss methods with no permanent weight loss and had some co-morbidities.

[armymom2012 51]

No NC2012, I did not go to the doctor for 6 months prior to deciding to get the band. Only when I was sick. But she had done Blood tests and other testing earlier that year to out rule other issues causing my problems. She also noted in her letter to Tricare that I had been her patient for over 5 years, that in itself may have shown consistent proof that she clearly knew my situation over a period of time.

I had mentioned the lap band once to her earlier that year after I went to the LB meeting, because I was still having joint issues and swelling in my legs, but other than that no. I came back maybe 3 months later and discussed to my Primary Care Doctor that I had decided to start the process and at that time she agreed that it would be a good solution to my situation, because I have Degenerate Joint Disorder, Glucose Intolerant, High Blood Preesure, Cholesterol and reaccurent surgeries for Cronic Heel spurs, which could help by losing the weight that I had not been able to do on my own. I was not the min. 100 over weight requirement, but the other issues over rode that decission for Tricare to approve me. Now even though Tricare approved me, towards the end of the process when I finally met with the surgeon, he also had to make his conclusion and approve me. Hope this helps you.