Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Looking for Tricare Prime Users



Recommended Posts

Hello my new friends -

Starting my journey to healthy living. I have Tricare Prime insurance (my husband is retired military). I called Tricare, and was told that they did not cover the sleeve surgery and would not say that they would not cover Plication. What I would like to know is, has anyone who has Tricare used their insurance for the sleeve. I just don't understand why they would rather me do a gastric bypass when it is more expensive!! Of course, I don't understand the insurance business anyway. I have 2 co-morbidities with 90 lbs to lose. Any help would be appreciated!!

Share this post


Link to post
Share on other sites

I have Tricare prime although active and in the process of getting the sleeve surgery and I have known a lot of people get it done through Tricare and had no problems with them.

Share this post


Link to post
Share on other sites

Thanks for your response. When you pull up what is covered on their website, it says it does not cover the sleeve. I feel like whenever my claim gets submitted with the co-morbidities, I can always ask for a review if they give me any trouble. I am determined to have this surgery one way or another, I would just rather it come out of their pocket instead of mine!!

Share this post


Link to post
Share on other sites

Tricare Prime does not cover the sleeve by civilian providers. I've been through the process. It is not covered.

I am the spouse of a retired Marine and had my sleeve done at Brook Army Medical Center. Unless you can get to a military medical facility that does sleeves, you will have to pay for it out of pocket.

Share this post


Link to post
Share on other sites

I wanted to add that I had several doctors offices incorrectly tell me that Tricare Prime would cover

the sleeve but when I checked with Tricare, they were very clear that they do not cover it.

I'm sorry. I know that's not what you want to hear and it is very frustrating. I was very lucky to be within driving distance (3 hours) of a military medical center that did the sleeve.

Share this post


Link to post
Share on other sites

Hate to hear that about Tricare. I looked on the VA website for Lexington, KY. All they show is something about MOVE. Is that the program you have to go through before they will do the sleeve surgery? If so, how long does it take? What hoops did you have to jump through to get your surgery? Thanks!

Share this post


Link to post
Share on other sites

Pugmadkate is correct. The sleeve is only covered if it's done at a military installation that does them. MOVE is their pathway program to WLS, though the name varies from facility to facility.

1). Referral from PCP to the program.

2). Enrollment in the next "class" which can vary. They limit the class sizes to about 20 people. I waited about 6 wks after being enrolled before my class opened. The first orientation class lasted about 3 hrs. You are introduced to the whole team of people: Surgeon, Nutritionist, Bariatric RN etc. Then you'll get a person-to-person visit with the surgeon that same day.

3). You are required to attend one support group meeting. They are only held once per month.

4. Two meetings / classes are required with the MOVE Program. They are about 6-8 weeks apart.

5). After the two MOVE classes, you'll have a one-on-one appointment with the dietician / nutritionist. You will be required to bring in your food journal and fitness journal to every appt you go to. You will be weighed at every appt.

..........The requirement is simply that you do not gain weight. You must either maintain your starting weight or lose weight - again, the latter not being required. You will have to do a 2 week liquid diet before surgery in order to shrink your liver so that the procedure can go smoothly.

6). If you have been compliant, the dietician usually clears you for surgery after one visit. If not, you'll have to continue individual nutrition classes until you demonstrate the ability to comply with a new way of eating and journaling.

7). Once cleared by Nutrition, your Psych Eval will be scheduled. Only one appt is required unless you are not cleared due to any "red flags"; if so, you'll have to return for another appt.

8). Once cleared by the Psychiatrist, your EGD gets scheduled and lab work repeated. If you have known medical problems that you see a specialist for, you'll need medical clearance from them around this time.

9). If your EGD is fine you are scheduled for a final appt with the surgeon to answer any last questions, then you are scheduled for surgery. If you are positive for H. Pylori, you will have to be treated with antibiotics until it is cleared; usually 2-3 weeks and they'll do a blood test to confirm that its presence is no longer in your belly before they will perform your surgery.

10). If your surgeon is NOT scheduled to deploy overseas or go TDY, and if you make every single appt and are compliant, surgery can happen about 4 months after beginning the process.

Hope this helps!

Share this post


Link to post
Share on other sites

I have Tricare standard as a secondary ins. I was told they will not cover me unless I was 100 pounds or more overweight. So I will be picking up what Medicare doesn't pay.

Share this post


Link to post
Share on other sites

Thanks for all the feedback. I have found out that Tricare will definitely not cover the sleeve or plication. My only other option is Gastric Bypass. I really hate to have a surgery I really hadn't planned on, but if I don't I will be out 15-20K. Bummer!!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Bashbee91

      Hey guys new to the process looking forward to this new life. 
      · 0 replies
      1. This update has no replies.
    • Bugg

      Hi everyone! I’m brand new here. I just went through all my pre-op requirements per my insurance company and now everything has been submitted and I’m just waiting for final approval and my surgery date. I’ve been doing research, watching YouTube videos, TikTok’s, ect.. trying to prepare my mind and what to expect so I’ll be ready for the surgery. I was so sure and so set and so ready and excited. However, now that I’ve done everything & it’s almost here, I am sooooooo scared! I know why I want it bc I’ve tried everything and I just don’t feel like I can lose weight by myself. I’m tired of being overweight my entire life. I’m miserable, but I keep psyching myself out afraid of GERD bc I know how that can be and I don’t want to have to get a bypass after already gaining the courage to even get VSG. I’m scared of complications like I’mgoing to regret doing it and be depressed that I didn’t just be more disciplined and try again to lose the weight on my own even sitting here typing this knowing in my mind i just can’t and don’t possess the discipline. I’m also afraid I won’t be able to handle the restrictions of the sleeve. What do I eat? I don’t know how to eat healthy really and don’t enjoy healthy food. I don’t know how to do this! I feel so defeated!Someone tell me they felt anything similar to this or am I not ready? I thought I was. I am so tired of being sick and tired and so tired of myself and so tired of being stuck and stuck in this body and somebody different on the outside from what I feel inside. I just want to ball up and cry.
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      over 20 lbs down since4 the pre surgery diet and surgery on the 14th
      · 1 reply
      1. Selina333

        Yay!! Congrats. I know how good that feels. 🤩

    • Jenopolis

      Had a sleeve in 2017, lost over 100 pounds. Had a DS surgery this year (2025) for more sustainable weight loss. 🤞
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      The 14th was my day. I am home and recovery is going pretty smooth. They even let me walk out of the hospital. Picture of me in recovery curtesy of my boyfriend lol. 

      · 3 replies
      1. DaisyChainOz

        Glad it went well!! Wishing you a speedy recovery and wonderful success!! 🤗

      2. buildabetteranna

        Thank you ❤️

      3. Selina333

        Neat you have a pic of this day! I was sooo happy to get my surgery. It was well worth it! And I'm not even near my goal. I had surgery Dec. 2!

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×