Working and waiting

[shmily 424]

I have seen the surgeon, attended his required wt loss seminar, checked him out for malpractice issues and his reviews, had my psychological, my nutritional, my blood work, seeing cardiology next week, I have my EGD scheduled for Jan. 9, 2014.....after that, we wait for insurance approval. Tricare does pay 100%. I have BMI of 49%, new diabetic, sleep apnea, high BP and cholesterol, asthma, knees have tears, back issues.....I think I will pass.....excited to get my life back

[skinny_minnie_wannabe 30]

I think you will too! Good luck!

[cfergie911 90]

I have seen the surgeon, attended his required wt loss seminar, checked him out for malpractice issues and his reviews, had my psychological, my nutritional, my blood work, seeing cardiology next week, I have my EGD scheduled for Jan. 9, 2014.....after that, we wait for insurance approval. Tricare does pay 100%. I have BMI of 49%, new diabetic, sleep apnea, high BP and cholesterol, asthma, knees have tears, back issues.....I think I will pass.....excited to get my life back

I have Tricare as well and the only thing that I had to do was the psyc eval and the 6 month supervised diet. That is a looooong list. But they are very quick for approval. It only took me a week to get a yes. Now I am just waiting for the scheduler to cal me with a surgery date, But you can do this!

[shmily 424]

I had to show a history of previous wt loss attempts with supervised programs this year such as Weight Watchers, which I did. The doc requires a 2 week program as well, before surgery. If I have to go 6 months, I will have to go on a med for my diabetes..........It only showed up in the pre-op AN1C

[shmily 424]

and knee surgery

[shmily 424]

I just check the Tricare site updated December 2013 and here is what it said.

If you meet all of the following conditions:

• You're at least 18 years old or you must provide documentation of completion of bone growth.
• You were unsuccessful with non-surgical medical treatments for obesity. Your medical records must show your failed attempts.
  • Diet programs, such as Weight Watchers®* and Jenny Craig*, are acceptable methods of dietary management, as long as there are monthly clinical visits with your doctor and medical documentation of your participation and your progress throughout the course of the dietary program. *These programs are not covered by TRICARE.
  • Physician-supervised programs made-up of only weight-loss medication management, do not meet this requirement.
• You have proof of one of the following:
  • A body-mass index greater than or equal to 40 kilograms per meter squared (kg/m2); or
  • A body-mass index of 35-39.9 kg/m2 with one clinically significant comorbidity, including but not limited to, cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, Pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy, or pulmonary hypertension.
• So I have met all the requirements, hopoing I don't have to do the 6 month thing, it didnt say anything about it. I will call them tomorrow

[jessiej1979 24]

I don't know what type of Tricare you have but my first appointment with my primary care doctor (addressing weight loss surgery possibilities) was August 19, 2013 and my surgery date is January 16, 2014. I have Tricare Prime. All I had to do was: (in no particular order) 3 dietician appointments, exercise physiologist, 5 documented support groups, information session, sleep study, psychological evaluation and I was approved two weeks after my initial doctor appointment. As far as showing failed attempts of weight loss programs, all I had to do was write them down.

I hope all works out for you. I've been on a 20 year diet it seems and my weight loss surgery journey has taken me 4.5 months. Good luck to anyone who reads this!!!

[jessiej1979 24]

BTW, my BMI was only 35.2, however, I have severe co-morbities that I believe helped to persuade Tricare to accept me, including severe high blood pressure (210/160), severe back pain, diabetes, high triglycerides (900's), and high cholesterol.

[shmily 424]

I have Tricare Prime and the surgeons insurance person told me they told HER, I had to have a letter of suport from my primary, stating my medicl conditions and what type of wt loss programs I had tried, WW or Jenny Craig had to be one of them. They then required the pre op blood work, a psychological eval, 1 visit, and 1 visit to the nutritionist. I have to see a cardiologist for clearance, that next week, and the surgeon will do an EGD at the hospital on Jan 9, 2014. I have body mass index of 48, and have several co-morbitities, though they are not needed with a BMI as high as mine. I was told I have completed all my requiremtns, once these other two appointments are donw, and then they will submit it to the insurance. After that, and if it is apporved, a surgery date will be scheduled and then I will attend a 2 hour class by the doctors hospital bariatic coordinator and thats it. After scheduling the DOCTOR requires a high Protein 1000 cal diet for two weeks to shrink any enlarged liver, to get me used to putting protein first and changing some habits. Maybe cause mine is Triwest, I don't know....

[shmily 424]

PS, no sleep study needed for me, I am already on a Cpap

[jessiej1979 24]

Maybe that's it, I'm Tricare Mid-Atlantic. Well, I certainly wish you the best!! Keep us posted.

[cfergie911 90]

I have tri-west prime and I had a minimal list.

-6 visits to the doctor discussing my diet and exercise (I dropped 25 pounds during this)

-psychological evaluation

no EKG, no sleep study, no visits with the NUT. I got really lucky. I am also only 21 so that might of had something to do with it. I go in on January 20th for surgery. I wish everybody the best!!

[jessiej1979 24]

Cfergie911, you were lucky!! Good luck to u! I'll be discharged when you're being admitted! My surgery is January 16th.

[shmily 424]

I guess it varies

[kespy74 103]

I have Tricare Prime south and my surgeon's office said I have to get three months of MD supervised diet on top of all the other clearances. When I called Tricare, they said it was not required. Oh well. It shouldn't be a problem because I went in on October, November and am trying to get in for December so the forms can be completed. My PCM has submited the letter of support, and I have completed my lab work, chest xray, ultrasound of my gallblader, cardiology, and pulmonology. I have an appointment with Gastro on January 6th and my Phsych appointment on the 9th. Hopefully I will get surgery in January or February.