Tricare Comorbidities...

[SinCityGal 43]

Does anyone know what would be considered a comorbidity for Tricare other than the ones listed on their site? I saw the surgeon today & he doesn't think insurance will cover me. He said that my high cholesterol won't count due to me not being prescribed meds for it! He also said no to my PCOS as well!

Any info would be greatly appreciated, Thanks!

[Puppypaws57 137]

do you have sleep apnea? That did it for me.

[SinCityGal 43]

No, I don't think so. That's what you had & got your approval?

[wjlochrie1 6]

Does anyone know what would be considered a comorbidity for Tricare other than the ones listed on their site? I saw the surgeon today & he doesn't think insurance will cover me. He said that my high cholesterol won't count due to me not being prescribed meds for it! He also said no to my PCOS as well!

Anyone info would be greatly appreciated' date=' Thanks![/quote']

Comorbidities that most insurance accepts are cardiac issues, high blood pressure, high cholesterol, diabetes, pre diabetes, bmi of over 40. Severe arthritis, spinal issues. All have to be documented by a physician. Having said that, Tri Care is a horse of a different color. You should talk to them. Have your surgeon send in diagnosis evaluation and see what happens. All hey can sa is no. Most surgeons will work out a payment plan with you if insurance doesn't cover. Also, check to see which drs r in networ. That is huge to them. I hope u get approved!

[SinCityGal 43]

Thanks for responding, really appreciate it!

[Puppypaws57 137]

Yes, sleep apnea was a co morbidity for me, plus my size. 252 - 5'2".

Tricare is usually very easy to get approval from. It was so easy that I had my surgery right away and didn't have to go through the classes, which in retrospect, was not the best thing for me.

[SinCityGal 43]

Puppypaws, how long ago did you have your surgery?

[Puppypaws57 137]

OK. I had two surgeries. One didn't work out. The last one was Dec. 13, 2011. I started at 252 and was 201 today. Slow loss, but I'm older, don't always make the best choices (lots of emotional/hunger issues I haven't addressed) and have trouble exercising. So all in all I'm happy with my loss.

Very happy with the band. If I did my part it would work like a charm!

[ArmyW!feLori 4]

I didnt have any co morbs myself. I fit into the "200% over ideal weight". Was easily approved and have lost 132lbs.

[SinCityGal 43]

I'm just at a 38 BMI with a few co morbs & not taking any meds for them! I'm going through my 6 mo process right now & don't want it to be a waste!

[blackmajyk 7]

I didnt have a waiting period..I have high blood pressure, high cholesterol, diabetes, and sleep apnea. i was approved within 2 days of submittal. So it varies by person..Its not a waste of time..go ahead and get an appt with the nutritionist..and get your psych eval to get that out the way.

[SinCityGal 43]

I go again on tuesday, I hope to start getting those appointments!

Thank you!

[DanitaOrr 0]

SinCityGal I am about to go down the road with Tricare. Good luck hon. I know they can be a pain in the butt at times but definately don't give up.

[jerbear 17]

I am tricare and had to go through the classes and some differant evaluations, but I think it was my surgeon that required them. I was approved no problem. The nurse and nutritionist at my clinic said tricare is one of the easiest to get approval from. My BMI was 39 and I had sleep apnea and High blood pressure. I had a referal from my nurse pratitioner. I did not have to do the 6 month supervised diet. It took me about 9 months to do all the classes, evaluations and wait for my turn to get a surgery date though. I sggest to anyone thinking about getting a lap band to get started asap because it does take some time but I guess it varies depending on what your surgeon and insurance requires and the number of patients your surgeon does. My surgeon was the only one in his clinic that did lap band surgery at the time. He has someone else with him now so the wait time for surgery date is not as long.

[SinCityGal 43]

Hi Jerbear,

How long ago did you have your surgery? Which Tricare do you have?

Thx!