Will Tricare Approve Me Now?

[MsKinthedesert 19]

I have been to 2 civilian surgeons, neither of whom told me that TriCare would not cover VSG outside a mtf. After finding this out for myself, I called the nearest Naval Hospital that does them and am awaiting a call for my first appointment with the surgeon there. I have already had a sleep study ( have sleep apnea and am now on a cpap), have had a psych eval done, seen a nutritionist and have another appointment for one, done 4 out of the 6 months of weight monitoring with my PCM that TriCare asked for. I have lost 14 lbs, my BMI is 51, I have hypertension and sleep apnea (2 co-morbidities), limited range of movement in my joints and I have been on this journey since Oct. 2011. I thought I wanted a Lap Band and decided to get vsg after doing the research. Can anyone think anything else I will have to do to get approval?

[Banned member 320]

Like you discovered you will have a better chance of getting a VSG at a military facility. It definitely sounds like you qualify but each MTF has it's own set of qualifications. From what I've read you don't have to work with Tricare in order to get the VSG as long as you're on a MTF. If all goes as planned I will be having my surgery at the mtf where we are stationed. My BMI is 41 and my friends BMI was 37 and she had her VSG done on post. Good Luck to you. Praying everything works out for you.

[MsKinthedesert 19]

Thanks -I pray all goes well for you, too.

[angeliiz80 38]

I have been to 2 civilian surgeons, neither of whom told me that TriCare would not cover VSG outside a mtf. After finding this out for myself, I called the nearest Naval Hospital that does them and am awaiting a call for my first appointment with the surgeon there. I have already had a sleep study ( have sleep apnea and am now on a cpap), have had a psych eval done, seen a nutritionist and have another appointment for one, done 4 out of the 6 months of weight monitoring with my PCM that TriCare asked for. I have lost 14 lbs, my BMI is 51, I have hypertension and sleep apnea (2 co-morbidities), limited range of movement in my joints and I have been on this journey since Oct. 2011. I thought I wanted a Lap Band and decided to get vsg after doing the research. Can anyone think anything else I will have to do to get approval?

I just had mine at Balboa Naval Hospital and it took almost a year. This is straight from my list: 2 educational classes, pass test, support group meeting, nutrition consult, healthy weight class, 6 month weight management (unless you have already exhausted different diets), blood&urine tests, nicotine panel (only if you smoke), psychology consult, PAP (within a year), mammogram (40 years and up only), lose 10% excess body weight (they may use your doctors number if you have already been losing), upper GI, chest x-ray, & sleep study (you already have so just need paperwork), these are possible extras gallbladder ultrasound, EGD, Colonoscopy (50 years and up), echocardiogram, internal medicine, cardiology consult and quit smoking for 3 months.

Good Luck and hopefully they will take care of you quick :*)

[Kalimomof3 613]

I will have mine done at San Antonio Military Medical Center on Nov 7th. The Bariatric program is a self refferal program and approval is fairly clear cut:)