Insurance Tricare?

[rkmom0506 11]

Tricare will only do a gastric bypass, Tricare will not authorize a sleeve. I called numerous times and they stated it was policy. They did authorize me for a gastric bypass but I couldn't do it. I went and had the sleeve done.

Ya know I had that feeling! My doctors office told me on day 1 it was covered now by them as of just a few months ago but something is just not sitting right with me. I had a feeling it wasn't. I don't want the bypass. Now I'm really bummed So did you pay for your sleeve out of pocket? I may end up just doing just that myself. Thanks for your information

Something changed with Tricare between October 2015 and this month. Sleeve was on the exclusion list which is why I didn't get it done last year. I just noticed a couple weeks ago it's now covered. See http://www.tricare.mil/CoveredServices/IsItCovered/BariatricSurgery.aspx - Also, I called and verified my benefit coverage with Tricare for procedure code 43775 (Gastric Sleeve In-Patient) and they gave me all the copay, etc. Anyone with Tricare should check it out.

[CandidShan 15]

Yes they recently changed policy. The sleeve is covered!

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[KattrinJ 4]

I'm dealing with Tricare North also. I have my first appointment with the surgeon, NUT, psych, etc at the end of March. I sure hope Tricare North does not require 6 months of pre-surgery dieting!!! I want it done NOW. I did have a run-around finding a surgeon that was Tricare approved.

Any more experience w/ Tricare North?

Thanks

[aelis63 1]

I am Tricare North, and even though it isn't stated in the policy that a 6-month diet/exercise plan is required, it is definitely required in NC. I am also standard. I spoke with a nurse that handles the authorization packages as well as a lead policy manager at Tricare. I was told they will kick it back denied if there isn't enough medical documentation for failed weight loss attempts, and this is covered with a 6 month plan. I hope that helps some!

[david.m.livingston 1]

Two weeks ago I was approved for the sleeve from Medicare as primary and Tricare as secondary. I started my pre-op diet one week ago and have lost 11 lbs so far and was wondering the insurance will have problems because my BMI has gone down? I still have a week to go before my surgery date. I don’t want to get to the hospital to have this surgery only to be told they can do it because I lost too much weight. My BMI was 43 at my initial appointment in January and is now 38. Does anyone think I will have problems?

About the diet plan or weight loss program, I never did one really. I am prior service and just told them that I was on the overweight program in the Army. My stuff got approved in 1 day.

[CandidShan 15]

Thank you everyone!!!! The sleeve is a covered surgery!!! I'm thrilled. My only hang up now is I don't have any doctor documents stating I had failed weight loss in the past???? I mean I went to my doctors for follow ups and Med refills and referral requests but never to have continued weigh ins for weight loss. I did weight watchers one year on my own and went from a size 18 to a size 4 all on my own but wasn't paying for weightwatchers. I had the points booklet from someone and used that. Looks like I may be in a pickle

The doc office will do it for you...

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[Lindsey Skinner Abbott 97]

Finally got approved for the sleeve! It only took Tricare 2 days for the approval! I had to have a sleep study done so that is what took so long to get all of my appointments done. So excited yet nervous. I have waited almost two years for this. So happy the sleeve was approved!

[reinventingmyself 47]

Congratulations! I am glad it worked out.

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[flip26 10]

Did any of you drop to tricare standard? I want to pick my WLS center?

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[KattrinJ 4]

Did any of you drop to tricare standard? I want to pick my WLS center?

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I am NOT an expert on Tricare at all - please talk to someone who is. BUT... If you drop from Prime to Standard... Won't you have to reach a deductible and pay a percentage???? With Prime, I'm going to have to pay about $25 dollars total. If you change, I think it will cost you $$$$$$.

[KattrinJ 4]

Let me update on my Tricare /Sleeve journey. I was APPROVED for the sleeve thru Tricare. I had to follow my surgeon's orders. I did NOT have to have 6 month diet, did NOT have to have 2 wk liquid diet prior, did not have to have sleep study (doctor's choice as I do not have sleep apnea). I did need to have the psych evaluation done. I have surgery July 8 -- in 2 days!!!

[letsbelosers 2]

I have tricare and was accepted for sleeve. I had to do psych eval, sleep study, barium swallow, labs, seminar, support meetings. I think it just depends on your dr.

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[flip26 10]

Yes I will have to pay 1000 deductible for each fiscal year and after that is paid my understanding is that standard will cover everything fully from there on out.

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[flip26 10]

Let me update on my Tricare /Sleeve journey. I was APPROVED for the sleeve thru Tricare. I had to follow my surgeon's orders. I did NOT have to have 6 month diet, did NOT have to have 2 wk liquid diet prior, did not have to have sleep study (doctor's choice as I do not have sleep apnea). I did need to have the psych evaluation done. I have surgery July 8 -- in 2 days!!!

Is your surgeon a military or a civilian doctor?

So happy for you.

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[KattrinJ 4]

Civilian doctor. I live too far from a base. You sure you want to have to pay $1000????

What state are you in? (If you don't mind sharing.)