Tricare prime

[mcclrm2 0]

Hello everyone! Currently I'm staying in Biloxi Mississippi and I'm having a hard time finding a doctor to get me started on the lap band. I am over 40 BMI so I'm guessing it shouldn't be as hard to get this done. My main concern is where do I start and does my insurance cover it? I have already tried gong to a nutritionist and other steps so what should I do?

[kazjim98 618]

You would be in the Tricare South region and the lap band is covered by Tricare Prime. Are you at or around Keesler AFB then? My first step would be to locate a surgeon in your area that takes Tricare, they will be able to tell you what Tricare requires, my region TriWest requires a 6 month supervised diet but your region may not.....Try looking online, this site has a surgeon search engine at the top of the page...You could even call Tricare and ask them which bariatric surgeons are in your network.....Best Wishes!

[☠carolinagirl☠ 18,721]

i have tricare prime north

my starting bmi was 62..no other issues besides being super morbid obese

my pcd referred me to trcare for this surgery

once tricare did, i had to fulfill all requirements and then submit for approval

per my ins (my hub is retired) i did not have a 6 month wait

[kazjim98 618]

CG mentioned something I forgot...you will need a referral from your PCP. I didn't need a referral until I was 4 months into my supervised diet, if I had got one before hand it would have expired, but if you don't have to do a supervised diet you will need one right away..

[mcclrm2 0]

Thank you for all the advice ladies! At one point I thought about giving up. I have changed PCM twice but now I have someone who has approved me to receive a referral. I don't want to get over excited because I know it has to be approved but I can't help but be excited. Just wondering how long it will take to find out if I'm approved. Hoping I can pick the location and doctor. Any suggestions? Going to be in Jacksonville Florida so I guess I should start looking around there.

[mcclrm2 0]

So I know I haven't been on in a while but here is my update. Everyone had really motivated me to continue and fight or happiness and health in my life! I moved to Florida and changed my PCM. The base referred me to out patient because of the age restriction. Now I have to go to the seminar today with Dr. Baptista before I can even make an appointment. I had a long talk with my provider and I'm torn between the lap band and sleeve gastroestomy. Any advice ladies? How are you doing with the band? I will try to update you as much as possible.

[mcclrm2 0]

Just found out today that my doctor does not require supervised diets. So all I'm waiting on now is an appointment for a h&p and two other appointment before surgery. I don't have a date yet until my approval comes after they send it off. Patiently waiting for some good news!

[candtwalker 46]

I remember Dr. Batista. He was a good doctor. I did not use him for my Lapband but I liked him. We were stationed in Mayport, but we are retired Navy in Houston now. I tried for approval for the sleeve through Tricare South and it was denied. But they did approve the band. I am happy with it, but I sometimes wonder if the sleeve would have been better for me personally.

I wish you luck and let us know when you get your approval.

[Cherie Murphy 22]

I remember Dr. Batista. He was a good doctor. I did not use him for my Lapband but I liked him. We were stationed in Mayport' date=' but we are retired Navy in Houston now. I tried for approval for the sleeve through Tricare South and it was denied. But they did approve the band. I am happy with it, but I sometimes wonder if the sleeve would have been better for me personally.

I wish you luck and let us know when you get your approval.[/quote']

I have TriCare as well and I have never done a surgery other than at a Medical Treatment Facility (hubby is AD). Even though my surgery is scheduled 6/20 I was told yesterday that I needed another blood test to get a pre-cert? I thought I was already approved if they scheduled my surgery? Has anyone else have this situation?

Yes I had to do 6 months of monitored diet even though TriCare said I'd didn't my doctor told me they would not certify me without it?

[MsGal 104]

I am also Tricare Prime (North). I have an appt today and I am going to make sure all the preauthorization has been done. My PCM referred me to Bariatric surgery with a low"ish" BMI due to Hypertension and boaderline diabetes. It is my understanding that Tricare will only approve bypass OR the band!

For the lady at Keesler.....(That is where I am from and I worked in the medical center for years)......they do bariatric surgery there. BUT....my best friend just got the sleeve at a private office on the coast. I would be happy to ask her who she used if you'd like!

Lisa

[kazjim98 618]

Just found out today that my doctor does not require supervised diets. So all I'm waiting on now is an appointment for a h&p and two other appointment before surgery. I don't have a date yet until my approval comes after they send it off. Patiently waiting for some good news!

Hoping you get the good news soon!....and I can't speak of the sleeve as I don't have one, but I love my band

[mcclrm2 0]

I have TriCare as well and I have never done a surgery other than at a Medical Treatment Facility (hubby is AD). Even though my surgery is scheduled 6/20 I was told yesterday that I needed another blood test to get a pre-cert? I thought I was already approved if they scheduled my surgery? Has anyone else have this situation?

Yes I had to do 6 months of monitored diet even though TriCare said I'd didn't my doctor told me they would not certify me without it?

I hope I don't have to do the six months diet....been through that. He said that I shouldn't buy I will keep you posted.

[Royalrags 24]

Hi I am in Tampa, Florida and have Tricare Prime, My primary care referred me to a Bariatric Physician back in February, I had to do a mandatory seminar, then on February 11th I had my first appointment with Doctor, I was then contacted by Surgical Coordinator that set me up to do nutrition, psych eval, another nutrition, and fitness evaluation, I had to pay out of pocket for those visits because doctors were not in Tricare network. I did EKG and bloodwork and May 21st they submitted to Tricare , May 22nd they approved and my surgery date was set for June 25th. 2 weeks from now and Counting..... right now I am doing liquids and Protein Shakes

[Cherie Murphy 22]

Hi I am in Tampa' date=' Florida and have Tricare Prime, My primary care referred me to a Bariatric Physician back in February, I had to do a mandatory seminar, then on February 11th I had my first appointment with Doctor, I was then contacted by Surgical Coordinator that set me up to do nutrition, psych eval, another nutrition, and fitness evaluation, I had to pay out of pocket for those visits because doctors were not in Tricare network. I did EKG and bloodwork and May 21st they submitted to Tricare , May 22nd they approved and my surgery date was set for June 25th. 2 weeks from now and Counting..... right now I am doing liquids and Protein shakes[/quote']

I started the process in November of last year with my PCM but started my nutritionist in January. I saw all the same DOSC's just not sure why my barriatric surgeons office did not send in the request earlier? I talked to the nurse today and she said I should hear back earliest tomorrow! I'm on pins and needles... I already started my two weeks of liquid and if my surgery is going to be delayed I'm not going to be happy!

[ADJL 685]

I have TriCare as well and I have never done a surgery other than at a Medical Treatment Facility (hubby is AD). Even though my surgery is scheduled 6/20 I was told yesterday that I needed another blood test to get a pre-cert? I thought I was already approved if they scheduled my surgery? Has anyone else have this situation?

Yes I had to do 6 months of monitored diet even though TriCare said I'd didn't my doctor told me they would not certify me without it?

I have Tricare prime SW - I had to do multiple bloodtests for Vitamin levels/blood sugar, etc. I didn't have to do the diet either. I started the process with a referral from my PCM at the beginning of March and was banded April 24th.

BTW...in the seminars that I went through there were people approved for lapband, sleeve, and gastric. At least at Fort Campbell there was no restriction on the type of surgery. I could have chosen any of the 3 that I wanted once my PCM referred me to bariatrics.