Here Are The Requirements For Tricare

[Guest usmcwifey]

I have been fighting with my PCM now for almost two years with this. I am 5 foot 9 inches tall and currently weigh in at 261. I keep tearing my meniscus in my knee, and I have had numerous issues with my lower back, I am now starting to get hip pains. I gained about 80 pounds all of a sudden in the matter of 9 months. It started out slow, and then all of a sudden I was gaining sometimes 25 pounds a month. I was very active at the time it all started. My PCM thought that it may be due to my thyroid and has me on synthroid now, and my thyroid is still 4.90. I also have GERD, and my blood pressure has been high most everytime I have went into the clinic.

I need some pointers as to how to get this ball rolling? I have tried everything, I can barely walk at times since I gained all this weight, and I was walking 30 plus miles a week before, and gaining all this weight. My mom has had a gastic, my uncle, two of my aunts, and my grandma. They all have gained weight all of a sudden, and then it just progresses into lots of heath issues for them.

I would also like to look half way decent again, not that I am ugly, but, gaining weight has made my self confidence go down quite a bit. I also feel that it may be putting a strain on my marriage as well since I can't go out and be active like we once were hiking up mountains, walking, jogging, and the many other things we did together as a family.

Any pointers, thoughts, or ideas would be appreciated!

Thank you for your time,

Ang

[blackcherry2002 5]

Usmcwife...I was with Tricare, I was very young, had a BMI of 46 though, and had a few extra problems but I don't think i had the required three or whatever and I was approved in a week. They are funky people at tricare. However I did want to note that as a person who gained 90 lbs in 9 months due to bad habits and unfortunately due to a thyroid that was up to 22, I can say that a 4.9 is still too high. They change the range to .3-3.0 a few years ago but many doctors don't follow it. I hope your doctor keeps you on synthroid as it sounds like you have borderline hypothyroidism. (Not such an issue with weight loss, but it will help with cholesterol, moods, etc.)

[FattyCakes 0]

WOO! HOO! I got my approval yesterday 7/14/09!! I have Tricare Prime - South and it only took 2 days!!! Now I'm waiting for the scheduler to give me a surgery date.

6/20/09 Seminar

6/22/09 PCM Visit - Letter of Necessity

6/23/09 Nutrition Eval

6/24/09 Psych Eval

6/25/09 EKG/Stress Test/History & Physical (Cardiologist)

7/10/09 Surgeon faxed packet (Friday)

7/14/09 Approval (Tuesday)

Good luck to all those who are just beginning the process. Take control of the process and move it along .

294/294/size 12

Thank you for sharing this!

[Perk25 0]

Hi everyone I'm just starting this process and hopefully I can get some where with it! I'm going to the dr next week and I pray he will at least submit a referral to talk to a surgeon. I'm 5'5, 5'6 I weigh about 240 dpending on the time of day I have back problems and depression from it but I don't know about anything else. I've been over weight since I was like 5 years old and have never been able to get my weight down for very long. I have a terrible family history of Diabetes, Stroke, Heart Attacks, Congestive Heart Failure, sleep Apnea so I'm hoping maybe that will have some impact on there decision. I think my BMI is 38.7. Any advice or anyone have a similar situation??

[kbrier2703 0]

confused. i went to seminar on saturday, have sleepstudy and lab work appointments for next thur ansd sat. alot of you are talking about getting referals from pcms, when does that come into play. i am going through weigh loss center in San Diego. I have tri care standard.

[Dave_NW 92]

confused. i went to seminar on saturday, have sleepstudy and lab work appointments for next thur ansd sat. alot of you are talking about getting referals from pcms, when does that come into play. i am going through weigh loss center in San Diego. I have tri care standard.

Look at the dates on those posts. Some are a couple of years old. Tricare changed some of their requirements over the last few years. But I believe a referral is still required, since your PCM has to recommend you to see a WLS surgeon.

I also went to a weight loss seminar this Summer, but the surgeon told me I had to have a referral from my primary care doctor before Tricare Prime would authorize him. That referral was approved within a few days. I jumped through all the other hoops pretty quickly, and I'm having surgery in a few weeks.

If in doubt, call Tricare and ask them what they require. They'll tell you what your plan needs.

Dave

[AvasMom 0]

Thank you all so much for telling how you got the ball rolling so to speak. I live in ND, and after seeing a Halloween picture I've decided its time to get something done. I've always been heavy since my Jr year in high school. My moms whole side of the family is big. But after doing some research online, I've discovered im approximately 100 pounds over weight.

Im 5'7" weigh about 232. Before I had my daughter in Jan. 08 I weighed 185ish (I had been there for about 3 years). After having my daughter I weighed 260 in the hospital, then got down to 220. After speaking with my Dr about weight loss pills I was prescribed ephedrine for a 3 week period. (Now mind you, every time that I go up to base to see my PCM I have a new one, I have never had the same PCM for more than a 3 moth period) I had never felt better in my life, and I dropped down to 212. My daughter will be 3 in Jan, and I have not had any luck with getting rid of the weight. I have a problem with sleeping at night, and staying awake during the day. I am prescribed an anti depressant, an anti depressant/sleeping pill, and an anti anxiety pill. I am supposed to go to a chiropractor for back pain at least twice a week but since the all mighty tricare does not cover that, I cant afford to go when I need to. I have recently discovered (After starting a new job) that I have a significant knee pain that flairs up once in a while in one of my knees.

So my question to all of you is that with a BMI of 36, being 100 pounds over weight, having back pain, sleeping problems, and depression.. How well do you think this will all go for me? I have an appointment in a week to speak to the Dr about my "sleep" problems that I have been fighting with for 3 years now. But they dont know my real reason for going in there yet!

[melzie_99 22]

I attempted to speak to a Tricare rep to see if surgery requirements they tell us are any different than what's on the website. I don't know if I got a bad rep or what but she flat out told me she couldn't tell me anything because then "everyone would know what we were looking for". Um, yeah, hence my call. I can't fake my weight and comorbidities; what harm is it going to cause for you to let me know what you require so I don't waste yours and the medical director's time? *sigh* Sometimes I HATE working with Tricare; when they work they're wonderful but fighting with them about stuff is just tiresome. Luckily the office of the surgeon I would be seeing has been much more helpful with giving me info. Now if I could just get an appointment with my PCM...

[AvasMom 0]

I was able to see my PCM 2 weeks after making the appointment. She put in the referral for me to see the surgeon no problem. My seminar is on the 23rd. It is a requirement before I can schedule a consult with the surgeon. I will post in my blog how it goes from there. Im sooo excited!:blushing:

[L12 13]

confused. i went to seminar on saturday, have sleepstudy and lab work appointments for next thur ansd sat. alot of you are talking about getting referals from pcms, when does that come into play. i am going through weigh loss center in San Diego. I have tri care standard.

Tricare Standard does not require a referral (neither does Tricare Reserve Select); only Tricare Prime does.

[melzie_99 22]

@AvasMom: You are very fortunate. By the time my appointment with my PCM actually comes, I will literally have been waiting 2 MONTHS to see him, and this is my first appointment with him, period. We just moved to this base in August and I've been trying to get in since October. I hope to God he will give me a referral and I won't need to see him again for anything else WLS related, or at this rate I may never get it done.