Getting nervous about Tricare North

[Bring It On 55]

I called Tricare North Representative and I was told there was NO supervised diet. After reading several posts on here about Tricare customers having to have 3-6 month diet supervision, I'm starting to get worried that my process is going to take longer. ALSO, I noticed one poster on this site that just had their PCP send a referral to TRICARE for the surgery (not just for the surgeon) and that took care of the weight loss attempts in the past. I hadn't been to WW or Curves in years. What other options do I have?

[71614new 3]

Don't be worried-bank on what your insurance rep told you. I'm TRICARE prime (west) & did have to do the 6 months & have 3 co-morbidities. If you have to do the diet, make sure you make appts with your PCM that are specifically coded for weight loss. I started my process 9/15/13 & just had surgery 7/16/14 b/c 3 of the appts weren't coded right & they found out my thyroid wasn't working then too. So I had 3 extra months of weight loss appts & 3 months with an endo to get my thyroid back on track before TRICARE would even let me see the surgeon. Also, I have no prior issues with mental health but that still took 4 months from start to finish. Also-I had to have my surgery off base at a civilian hospital so if you're scheduled to have all pre-op appts done at a Military Treatment Facility then it may go faster for you. Oh, if you're not going through a MTF be prepared to pay out of pocket a little. My out of pocket was $1200 even though TRICARE covered the procedure. Hang in there, if you do have to wait - time will go by fast, if not, even better!!!

[theiamsbunch 2]

I am Tricare North, Standard, retired. I just did the 6 month diet/lifestyle classes through my surgeon's office. Easy-peasy, no problems with Tricare. All the pre-op appointment stuff took place during that same time frame, so it all worked out.

[catdaddy 232]

Hey all, I'm retired AF with Tricare prime south. Everything went smooth with the approval. Just follow the Tricare requirements. By the way it's three months supervised dieting. My approval took about a week for approval after it was submitted.

[Bring It On 55]

Thanks for the replies. My first surgeon appointment is August 7. On that day I see the exercise physiologist, nutritionist, surgeon, and psychologist. They told me it usually takes about 1 week for Tricare response. Tricare has already approved visit to the WLS center, so I feel like it won't be a big issue. I went ahead and called my PCP and she is sending a letter of medical need to be sent with the surgeon's claim to Tricare. Still lots of unanswered questions, but I guess I will know it all in about 2 weeks.

[catdaddy 232]

Best of luck Bring it on. Everything will go fine for us both and our future will be great.

[71614new 3]

It's weird how different the same insurance is in different regions... Either way you'll be on the losers' bench soon!! Woohoo! So good luck & keep us updated please!

[angelicHG7 118]

I'm tricare south...

They gave me my initial referral to the surgeons office for 4 visits.... Which included the nutritionist. The office is very well versed in tricare speak apparently, so they are pretty certain mine won't be an issue.

[dacarter 1]

It's weird how different the same insurance is in different regions... Either way you'll be on the losers' bench soon!! Woohoo! So good luck & keep us updated please!

Isn't it interesting? I started my journey in the south region which requires several labs a three month diet as well as NUT and psych. I moved to Tricare north with standard and I'm only required 2 NUT visits and documented weight loss attempts. My surgeon the required the psych eval which was nothing. Easy approval.

[Bring It On 55]

I'm tricare south...

They gave me my initial referral to the surgeons office for 4 visits.... Which included the nutritionist. The office is very well versed in tricare speak apparently, so they are pretty certain mine won't be an issue.

That was what I got - 4 visits through 3/2015.

[Bring It On 55]

Isn't it interesting? I started my journey in the south region which requires several labs a three month diet as well as NUT and psych. I moved to Tricare north with standard and I'm only required 2 NUT visits and documented weight loss attempts. My surgeon the required the psych eval which was nothing. Easy approval.

I don't have any documented weight loss attempts, but I do have diabetes and sleep apnea. I am hoping the letter that my PCP prepared for the insurance company stating medical need and weight loss attempts through her for the past year will suffice. What do you think?

[catdaddy 232]

I didn't have any documented weight loss program history ether. I told them about using colored weight loss pills and how I always battled weight gains. It's real how you tried to loose weight. Because you think you don't have anything to write down you really do. State your efforts with estimated dates. Tricare says Weight Watchers and Jenny Craig are used as good documentation. I joined Weight Watchers because of the requirement but it was the same dates as my three month doctor supervised diet. For me Tricare didn't check if I was a member or not. The following is straight out of the Tricare requirements. It will all be good for you so try not to worry to much.

TRICARE will cost share any of the following open or laparoscopic bariatric surgical procedures:

Roux-en-Y gastric bypass

Vertical banded gastroplasty

Gastroplasty (stomach stapling)

Adjustable gastric banding (i.e., adjustable LAP-BAND®)

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.

TRICARE does not cover the following services:

Office visits solely for the treatment of obesity

Non-surgical procedures for treatment of obesity

Nutrition and diet counseling

Biliopancreatic bypass (jejunoileal bypass, Scopinaro procedure)

Gastric bubble or balloon

Sleeve gastrectomy

Gastric wrapping/open gastric banding

Unlisted procedures

[dacarter 1]

I don't have any documented weight loss attempts, but I do have diabetes and sleep apnea. I am hoping the letter that my PCP prepared for the insurance company stating medical need and weight loss attempts through her for the past year will suffice. What do you think?

My surgeon had me fill out a sheet of everything I've tried and dates. Also I included what happened. I was nervous so I also included receipts of all the times I ordered medifast and other programs. The scheduler says they've seen just the question and answer sheet faxed and accepted. Standard north seems to be easy in regards to getting approved versus my experience on prime. It's actually why I switched.

[Moorefamily0214 7]

Hey guys I'm prime west and I'm thinking that I should switch to standard for easy approval? What are the out of pocket costs for those of you that used tricare Standard vs prime??