Referral & active army insurance question

[ms_adams 0]

I am new to this app. I am married to an active duty Army soldier. We are stationed at Ft Stewart GA. I was approved for the sleeve on post however the surgeons are deploying in May and do not have anymore slots until after we pcs in Oct. Problem is we don't know where that will be yet lol. I was wondering if I could get a referral for off post in Savannah and have our insurance cover it for the sleeve? I've gone through all of the steps to have it. Even the EKG that can be done again on post for free if need be. I don't know who to turn to. I really want to have this done before my husband leaves for Recruiter school in July 2014. Any help is greatly appreciated.

[LouiseandThelma 8]

Just in case no one has answered your question yet . I'm a Navy dependent and just went through the process in Maryland. Tricare doesn't cover the sleeve on the outside, even if you have a referral from your PC on post. I know that Tricare North doesn't up here. You can call Tricare South and ask them what they do cover. IF by any chance you were to move up here to the Maryland area...Do NOT take USFAMILY-Tricare with Johns Hopkin until you have had your surgery at a MTF. They only cover the Lap Band and Roux-en-Y bypass. I found out two weeks before I was scheduled to have my surgery. We are moving this June, so I decided to wait until we are settled, then I will start looking into surgeons. I hope this has helped! Good luck!

[mrzsmitty2015 1]

they cover it now?

[LouiseandThelma 8]

Mrzsmitty2015,

No Tricare and USFAmily does not cover the sleeve. What insurance to you have? Do you go to the base clinic?

[mrzsmitty2015 1]

i have tricare but we go to john hopkins.

someone told me they cover it now

[mrzsmitty2015 1]

a friend of mines is getting her sleeve done tomorrow with tricare insurance

[LouiseandThelma 8]

Wow! I fought them for a year was told Tricare doesn't cover the sleeve. I called them back in September before I started the process over down here in Florida and was told the same thing. Is your friend in MD?

[mrzsmitty2015 1]

yes she is here in maryland. he husband is active duty navy as well.

[mrzsmitty2015 1]

ill find out on wednesday if mines will happen

[LouiseandThelma 8]

Good luck and let me know how it turns out for you. I don't understand why Tricare hasn't covered the sleeve before now. Is she having her surgery at Johns Hopkins Bayview?

[mrzsmitty2015 1]

Yes, but here are certain conditions that must be met.

TRICARE cost shares on any of the following open or laparoscopic surgical procedures:

1. Roux-en-Y gastric bypass
2. Vertical banded gastroplasty
3. Gastroplasty (stomach stapling)
4. Adjustable gastric banding (i.e., adjustable LAP-BAND^®)

ONLY when all of the following conditions are met:

• You're at least 18 years old or you 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’s medical documentation of participation and monthly clinical visits with your doctor.
  • *These programs aren’t covered by TRICARE.
  • Physician-supervised programs made-up of only weight-loss medication management, don’t 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.

it covers it not sure why they you that. i would fight them on it.

[Schoe394 7]

I just had the sleeve done on 10/28 and Tricare covered it but it had to been done at an MTF.

[mrzsmitty2015 1]

i heard it depends on where you are living. i go to a john hopkins clinic military base is about 30 mins from us

so i assume because we dont live close to the base maybe thats why they allowed her to get it done at john hopkins. im just assuming. im going wednesday so ill find out if everything will be good to go with me.

[LouiseandThelma 8]

I did all the requirements for Tricare and Johns Hopkins. Now I am starting over again. But this time I'm using a MTF in Florida. I have almost completed my requirements one more month and I will finished up. Hopefully having surgery in Jan/Feb.

[mrzsmitty2015 1]

yes she is