TriCare WLS Prerec Experiences?

[ashly200423 8]

I didn't know they sent you there for surgery. We were stationed in England. They wouldn't let me start because we had less them 18 months left there

[Lindsey Skinner Abbott 97]

They are not sending me to LRMC for surgery we are currently stationed at Ramstein. We are not moving to Lakenheath until May. There is a patient coming from England for the surgery but I am unsure of her circumstances. The surgeon at LRMC is starting a entire new program. He hasn't even started doing surgery...he will start doing them in January. From my experiences with MTF's much of the decision is up to your PCM. My PCM is very encouraging and helpful...willing to do what she can to help the process.

[ProjectMe 909]

My two youngest were born at Lakenheath I have fond memories of living in England. We were stationed at RAF Mildenhall from 2000-2003 and lived in base housing inThetford. If you get the chance tour Bath...my most favorite place!

[wifeaf 0]

@@ProjectMe I guess I'm lucky then... not even 25 but I've already had a colonoscopy so I have a general idea of what's going on. =P Not something I'm looking forward to doing again anytime soon, lol.

@@Lindsey Skinner Abbott You're stationed where my husband is! I'd rather not mention his name, but just know that one of the nerdy looking dudes you see on base is my husband, haha. I've heard a lot of nice things about that base, though, so I'm jealous that he's leaving in, like, less than a month, so I didn't get to join him there.

[gottalosethis 0]

I'm considering the sleeve as well and have found Tricare doesn't cover. I'm very leery of MTF however if it's free that at least makes me want to explore it! Do any of you know if Wright Patterson in Dayton ohio does the procedure? My PCM is off base...tried calling base no one knew and could figure out where to transfer me. So wonder if that means they don't.

[HopefulMe2016 9]

The sleeve will be covered if it is done at a military facility that has a bariatric program. If you don't live near a post that has one, you'll have to get a referral from your PCP to a bariatric center, where you will have to follow whatever their protocols are; Tricare will only cover gastric bypass.

If there is a bariatric program at your post's hospital, you have to do the following to have a VSG:

-Get a referral from your PCP to the bariatric program.

-Attend the bariatric seminar, meet the surgeon and other members of the bariatric team (nutritionist, nurse, coordinating staff). You will be weighed and vitals taken which will be used to measure your progress and compliance.

-Attend their nutrition / weight loss program. One class is required, but continued participation is suggested.

-Maintain a food diary per the guidelines provided in the nutrition class (MyFitnessPal etc).

-Maintain or lose weight. Weight loss is not required, but you CAN NOT gain weight.

-Stop smoking. They will routinely check for cessastion via a urine test.

-Attend one bariatric support group meeting.

-Have a one-on-one session with the nutritionist who will check your food diary for compliance. Once cleared by the nutritionist, you'll be scheduled for a Psych appt.

-Get cleared by the psychiatrist (usually one appt, but more than one session may be required).

-After the psych clearance, an EGD will be scheduled to check for H. Pylori, hernias, and you may also have an ultrasound to check your gallbladder.

-Bloodwork is redone and if you see any specialists (cardiologist, pulmonologist etc), they'll need to clear you for surgery.

-Final meeting with surgeon. Surgery date scheduled.

-Length of time from beginning the program to having surgery varies. Could be a couple of months or closer to 6.

Hope this helps.

this makes me very sad. I have my seminar on the 19th of January and I refuse to have a bypass. Looks like I will have to wait until I get a job that offers insurance.

I was told by my PCP that the military is now leaning toward the sleeve and all her patients had the sleeve and we don't have a hospital at our base. I wonder what the heck she was talking about.

I'll talk to my surgeon's PA at my seminar and see what my options are, if I can't get the sleeve WLS is off the table for me.

[prettyCali916 299]

Hi! As of November this year Tricare is authorizing the sleeve. My surgeons office called to get my insurance info and was told the procedures that were covered but the sleeve wasn't mentioned. The rep told her to submit for it anyway because it was newly approved and that it is covered. My insurance packet was submitted for auth on 12/8/15 and 12/11/15 it was approved for the sleeve. I have no comorbidities, 42 bmi, and 5 months of Optifast documentation from 2013 as my "documented attempt at prior weight loss".

Tell your doctor's office that they are updating their information but to submit it anyways. Good luck!

[prettyCali916 299]

And you can call Tricare yourself as well, they told me the same thing. The girl that answered was actually in the process of prepping for the approval process for her own surgery too!

[Lindsey Skinner Abbott 97]

What Tricare are you in? I just called TriWest and they said that the sleeve is still not approved?

[prettyCali916 299]

I'm Triwest - UnitedHealthcare Military West. Whoever you spoke with probably looked at the requirements online or something - your doctor needs to submit for it anyway. It will go through.

[hubbywife 27]

I am in tricare south (humana military). I have my seminar scheduled for 12th of Jan. For me my PCM referred me. BMI 35 and 1 co-morbidity. I was approved with no problem.

I was also told sleeve isn't covered through tricare. However, Our hospital on base does the sleeve and the hospital is covering cost and doesn't go through tricare at all. General surgeon called and scheduled seminar. I stopped in and spoke with nutritionist and she explained that process in more depth. All is required is 2 support groups (1 can be attended pre-op) which is what I did. 1 psych eval. She gave me number for that and said I can have that done prior to seminar as well. Did that last week. When I called and scheduled appt. She submitted to Tricare for approval that day and they covered it 100% next day. I meet with nutritionist same day as seminar. Then labs will need to be done again and meet with surgeon. Thats it. She said since seminar is Jan. then procedure will be Feb or March since December patients are being scheduled for Jan. No out of pocket expense and no tricare authorization. They said once general surgeon office called I was automatically approved! My PCM did not think I would get approved because I'm low BMI for their standards but I got a call few days later. I also spoke with people in support group (pre-op and post-op patients) they all verified that is the process. No 6 mth pre-op diet. Just the liquid diet right before surgery to shrink liver!

[HopefulMe2016 9]

Hi! As of November this year Tricare is authorizing the sleeve. My surgeons office called to get my insurance info and was told the procedures that were covered but the sleeve wasn't mentioned. The rep told her to submit for it anyway because it was newly approved and that it is covered. My insurance packet was submitted for auth on 12/8/15 and 12/11/15 it was approved for the sleeve. I have no comorbidities, 42 bmi, and 5 months of Optifast documentation from 2013 as my "documented attempt at prior weight loss".

Tell your doctor's office that they are updating their information but to submit it anyways. Good luck!

Oh my word...this...wow. I'm just so happy right now. I know it will be a process but just knowing I MAY be able to get the surgery makes me so relieved. I'm actually shaking.

Thank you, thank you so much.

The nearest MTF to me that does the surgery is 2hrs away and that's just not feasible for me and my family.

Happy New Year ladies and gents

[HopefulMe2016 9]

I am in tricare south (humana military). I have my seminar scheduled for 12th of Jan. For me my PCM referred me. BMI 35 and 1 co-morbidity. I was approved with no problem.

I was also told sleeve isn't covered through tricare. However, Our hospital on base does the sleeve and the hospital is covering cost and doesn't go through tricare at all. General surgeon called and scheduled seminar. I stopped in and spoke with nutritionist and she explained that process in more depth. All is required is 2 support groups (1 can be attended pre-op) which is what I did. 1 psych eval. She gave me number for that and said I can have that done prior to seminar as well. Did that last week. When I called and scheduled appt. She submitted to Tricare for approval that day and they covered it 100% next day. I meet with nutritionist same day as seminar. Then labs will need to be done again and meet with surgeon. Thats it. She said since seminar is Jan. then procedure will be Feb or March since December patients are being scheduled for Jan. No out of pocket expense and no tricare authorization. They said once general surgeon office called I was automatically approved! My PCM did not think I would get approved because I'm low BMI for their standards but I got a call few days later. I also spoke with people in support group (pre-op and post-op patients) they all verified that is the process. No 6 mth pre-op diet. Just the liquid diet right before surgery to shrink liver!

I know that if you have it done at a MTF it is free, but I don't have one near to me. So I would go to a hospital in my area and use a civilian surgeon as well.

The tricare site still says it's not covered. I'm going to keep going with my process anyway, I know after 20yrs of being associated with the military, active duty and now a dependent I know updated info trickles in like icebergs. LOL

[prettyCali916 299]

Hi! As of November this year Tricare is authorizing the sleeve. My surgeons office called to get my insurance info and was told the procedures that were covered but the sleeve wasn't mentioned. The rep told her to submit for it anyway because it was newly approved and that it is covered. My insurance packet was submitted for auth on 12/8/15 and 12/11/15 it was approved for the sleeve. I have no comorbidities, 42 bmi, and 5 months of Optifast documentation from 2013 as my "documented attempt at prior weight loss".

Tell your doctor's office that they are updating their information but to submit it anyways. Good luck!

Oh my word...this...wow. I'm just so happy right now. I know it will be a process but just knowing I MAY be able to get the surgery makes me so relieved. I'm actually shaking.

Thank you, thank you so much.

The nearest MTF to me that does the surgery is 2hrs away and that's just not feasible for me and my family.

Happy New Year ladies and gents

Happy New Year!!

I called last night and they are still saying it's not so I asked for a manager and she said she is aware that it is going through since the codes are updated in the system but that until the Tricare.mil page changes their information, they cannot say anything else to members. Which really sucks to be honest. People are walking around thinking it's not covered which is not cool. I am lucky that my doctor had just attended a conference and it was announced there that it was now covered (something about how Medicare now covers it so Tricare can now too - don't know how or why that's related but it is).

Anyways, I'm so glad you are going to continue on with the process. I wish you the best!!!!

[prettyCali916 299]

I am in tricare south (humana military). I have my seminar scheduled for 12th of Jan. For me my PCM referred me. BMI 35 and 1 co-morbidity. I was approved with no problem.

I was also told sleeve isn't covered through tricare. However, Our hospital on base does the sleeve and the hospital is covering cost and doesn't go through tricare at all. General surgeon called and scheduled seminar. I stopped in and spoke with nutritionist and she explained that process in more depth. All is required is 2 support groups (1 can be attended pre-op) which is what I did. 1 psych eval. She gave me number for that and said I can have that done prior to seminar as well. Did that last week. When I called and scheduled appt. She submitted to Tricare for approval that day and they covered it 100% next day. I meet with nutritionist same day as seminar. Then labs will need to be done again and meet with surgeon. Thats it. She said since seminar is Jan. then procedure will be Feb or March since December patients are being scheduled for Jan. No out of pocket expense and no tricare authorization. They said once general surgeon office called I was automatically approved! My PCM did not think I would get approved because I'm low BMI for their standards but I got a call few days later. I also spoke with people in support group (pre-op and post-op patients) they all verified that is the process. No 6 mth pre-op diet. Just the liquid diet right before surgery to shrink liver!

I know that if you have it done at a MTF it is free, but I don't have one near to me. So I would go to a hospital in my area and use a civilian surgeon as well.

The tricare site still says it's not covered. I'm going to keep going with my process anyway, I know after 20yrs of being associated with the military, active duty and now a dependent I know updated info trickles in like icebergs. LOL

Yep. I agree. Everything is so slow. I'm at Travis AFB and they would do it but I would never go to the MTF for anything. I see civilians for everything.

Good luck with your process!