Tricare North - Bariatric Help

[IWantToBeALoser 0]

Hi! I need some help with several things concerning Bariatric surgery, insurance and... well just getting the ball rolling.

Specifics -

Age - 26

Gender - Female

Height - 5'4"

Weight - 250

BMI - 42 (approx)

Insurance provider - Tricare North (Prime)

I have scoured the internet for a while looking for information on what Tricare North covers and what the requirements are (according to their website).

What I'd really like to know are the real-life experiences of other people that have Tricare North and have gone through with the surgery. I'm looking into the bypass as opposed to the band (and I know getting the sleeve with Tricare is tricky.)

I have battled obesity since about 2009. I used to be an athlete and trim, but bad life choices and life in general have taken their toll. I have been going to the gym and trying to eat right but as the years go by I haven't noticed much change for the better.

Any advice is welcome.

What does Tricare North (Prime) require as far as supervised nutritional programs (and length)?

How long did your process generally take?

Do I need to get a referral/letter of Medical Necessity from my PCM? Or will a package for approval from the actual Bariatric office do the trick?

There are a few seminars scheduled in my area soon and I plan on attending...

But I'd like some real-life experiences/advice from people that have already gone through it.

I'm ready to take this to the next level. I'm tired of the yo-yo. I want my life to change for the better.

I just feel overwhelmed at all the paperwork I assume will need to go into this and can't see the forest for the trees, haha.

Thanks in advance.

[YngGram 73]

I am Tricare North Standard. In 2009 I was 5'2", 253 lbs., BMI 46 with HBP, cancer, and depression. Approved for lapband in a day. They required my weight history, mental health eval, other things were doctor requirements. I lost about 80 lbs. and kept it off for 6 years. Band started giving me issues with my esophagus and needs to come out. TriCare approved removal in a day, denied a revision to bypass. However, my doc did a peer to peer; on the website it looks like they have now approved the revision. That's not official yet, but if it is then it only took about four days for them to make that happen.

[IWantToBeALoser 0]

@@YngGram - thank you for that information. Also congratulations on the loss and I hope you get approved for the revision!

[DONNK 14]

Hello, I also have Tricare north Prime. I just had bypass surgery 11 days ago. They required me to have 6 months of dr supervised weight loss monitoring. Which for mine I got to do 6 nutritional classes with weigh ins. I am 5'3 was 248. BMI of 40. Had no problem with tricare at all. Good luck to you.

[IWantToBeALoser 0]

@@DONNK - thank you! Congratulations on the surgery, I hope you recover quickly!! ^.^

Edited August 31, 2015 by IWantToBeALoser

[395Ron 396]

@@IWantToBeALoser - Last year when I started looking into Gastric Bypass I was informed that Tricare Prime (not sure what Tricare North is) changed to 3 month supervised diet. I did that and had everything in order and they approved me very quickly for surgery in February. I had to post pone that surgery and am now scheduled for a 6 October surgery. I have found the doctors office to be very knowledgeable about what it takes for Tricare approval. Good luck in your process.