Tricare - does is, or does it not

[minpinmom 2]

Tricare covers Lapband no matter what region you are in. Some regions were slower in getting their systems updated.

[CnSHawk 0]

:thumbup:That is sooo awesome minpin!!!! How R U feeling?

I have Tricare, and had my surgery on Tuesday, I had to pay a $12.00 copay for my first consult with the surgeon, then $11.00 for the hospital stay. Sweet!

No diets, no psych eval, no nutritionist, nothing - if you qualify, they pay at 100%

Your Dr. may be out of network - or doesn't have their facts straight - Tricare is so new at accepting Lapband, not all the Dr.s know about it.

[minpinmom 2]

I feel great except I am starving! I can't wait to have some thicker drinks tomorrow. I really don't have any pain, it is uncomfortable, but not enough for meds. (and I am a self-confessed wimp)

[mynmann 0]

Am I in the same "south" region as you minpinmom? I am in Georgia... and that's about as "South" as you can get. One more rebel flag or mud bogging party and I may just go nuts. I wish my hubby could go active and us move to Europe for 4 years.... but he's stuck in the Gaurd "atleast until after this whole Afganistan deployment".

As for Tricare:

I know I'll have to have "commorbidities".. can't spell, but I don't know if Tricare requires 1 (one) or 2 (two) needed. My BMI isn't even over 40 so I know I'll need that to get approved. My weight as of today is 137 and I'm 5'6. So I'll have to gain to even be 100 pounds over. I can't believe I'm so fat I can't even see my feet and I have to hold my breath to tie my shoes but they think I have to get fatter before they'll help me. :confused2:

Does anyone know how high your BP has to be to be considered "high" for it to be a Tricare commorbidity? My BP at home is around 126/96. The top number goes from 125 to the 140's. The bottom number is never really under 90 and has gone to 101. Is that high? The bottom number seems higher than normal but the top one seems low?

Also, what "comorbidities" are excepted? Like I have Asthma... but I haven't had any bad flair ups in years.... does that count?

[mynmann 0]

Height and Weight Chart - height weight chart, weight height chart

[minpinmom 2]

I am assuming you are 237 not 137 :-) that sounds sad to say, but hey if you were 137 you would be wanting the band! I copied this out of the Policy for you - if I were you, I would go to Tricare online and research each associated medical condition to see what sets it as a "condition". I was lucky, I was fat enough not to have co-morbidities -wow is this a screwed up world we live in!

TRICARE POLICY MANUAL

II. DESCRIPTION

Morbid obesity means the body weight is 100 pounds over ideal weight for height and bone structure, according to the most current Metropolitan Life Table, and such weight is in association with severe medical conditions known to have higher mortality rates in association with morbid obesity; or, the body weight is 200% or more of ideal weight for height and bone structure.

. . . .covered when one of the following conditions is met:

1. The patient is 100 pounds over the ideal weight for height and bone structure and has one of these associated medical conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints.

2. The patient is 200% or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category.

3. The patient has had an intestinal bypass or other surgery for obesity and, because of complications, requires a second surgery (a takedown).

[mynmann 0]

No, I don't weigh 137. I wish! Typo. Right now I wish I weighed 337 though. Isn't that odd, wishing to be fatter! Every time I start talking about gaining more weight to meet qualifications for this procedure my poor husband gets this scared look on his face. He says nothing, which is smart on his part. I do wonder what is going on in his brain though. Probably, "NOOOO!!!!!!!!!!!!"

I am going to be forced to go talk to someone in person. I get more lost every day. I tried to look into it online. At

Humana Military Healthcare Services Beneficiary Standard Handbook - Exclusions

but just got more confused than ever. I am not Tricare Prime, not until they deploy my spouse. For now I am Tricare Reserve Select. Which is "from what the website said" very similar to Tricare Standard. I was worried about the coverage difference when I read you were on Prime. I didn't know what the difference was. I was hoping not much, since we have to pay $230+ a month for it.... but now I'm scared. This link says it's "Excluded", atleast I think that's what it said. BUT, the lady my husband spoke with on the phone said it was covered.... which was our whole reason for getting it prior to his deployment. Otherwise we'd of just waited and saved some cash. I just COULDN'T wait to get this done. Now, if they don't cover it.... well I guess I'll just have to deal. But, I won't be happy. I'll let you guys know what I find out.

If their are any Tricare Reserve Select folks on here that have gotten the surgury and it was covered then I would LOVE to speak to you too! :thumbup:

Myn

[miissxangela 0]

TRICARE POLICY MANUAL

II. DESCRIPTION

Morbid obesity means the body weight is 100 pounds over ideal weight for height and bone structure, according to the most current Metropolitan Life Table, and such weight is in association with severe medical conditions known to have higher mortality rates in association with morbid obesity; or, the body weight is 200% or more of ideal weight for height and bone structure.

. . . .covered when one of the following conditions is met:

1. The patient is 100 pounds over the ideal weight for height and bone structure and has one of these associated medical conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints.

2. The patient is 200% or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category.

3. The patient has had an intestinal bypass or other surgery for obesity and, because of complications, requires a second surgery (a takedown).

Oh nooo, I'm worried now :/ I don't have any of those comorbidities listed. I have told the dr. my problems associated with weight are: joint pain, depression/anxiety, and irregular menstrual cycles. Although I do have joint pain, I don't believe I have severe arthritis. I am also not exactly 100lbs overweight. I, too have been trying to gain weight. I know that sounds bad, but it's worth it, because if I wait a few mos, I would gain the weight anyway. I am 5'3" 221lbs. If I had a small frame, I would be over. If med. I have a couple lbs to go. How do you tell what size frame you have?? Ahh, now i'm kinda freakin out! haha

EDIT: I just googled Hypothalamic Disorders & apparently that is a wide range of things. I think that can be my irregular cycle and also excessive sweating (didn't realize i could use that as a problem)... so I'm hoping this will be ok? Any thoughts?

[minpinmom 2]

Don't worry about what you read on the online manual - the actual manual hasn't been updated - there have been new RELEASES of updates, but if you search the manual, it will still say excluded.

My Dr. told me I was Medium boned (measurement of wrist/elbow or something) But I am pretty sure he put in my paperwork that I am small boned, either way, my surgeon was the one who sent the letter, and he WANTED me to have the surgery, as yours will too - they will help you however they can.

For Small boned 5'3" woman, the Met Life Ideal Weight is 111lbs - 124lbs. You have to be 100 lbs over (both ends), so if you are 224 or heavier, you meet qualifications with co-morbidities. If you have no co-morbidities, then you must be 248lbs or more (for the 200%)

The coverage for Tricare (I have been told) is the same except you will possibly have a deductible/higher copay/etc. The actual coverage should be the same.

I would call Tricare and if you don't get answers you like, keep calling, all Tricare Operators are NOT created equal!

[miissxangela 0]

Thank you so much.. that eased my mind a bit. I weighed 221 at the doctors office last week. I am going to aim for 224 for this week and hope that my dr. will fudge it a little and that some of my weight related problems will pass as comorbidities. I'm sorry I have been freaking out and so annoying this past week. I am so anxious and nervous that I'm not going to be approved!! Thanks again, you have been so great!

[minpinmom 2]

I have heard of people putting ankle weights on under their jeans for weigh ins too - you can wear lots of layers, heavy steel towed boots - there are lots of ways to get your weight up without having to resort to gaining. Don't get me wrong, gaining has never EVER been a problem for me - but if you need it, you can get inventive for weigh ins.

[miissxangela 0]

thanks.. i'll be sure to keep that in mind!! I think I might also just drink a lot of Water before I go for my appointment..that seems to work

[mynmann 0]

I adore you. You are like the "Lap Band Hero". Just so clever. I've been eating everything in sight. Still worrying I might be 1 pound under.... now I'll just shove tiny little weights from my ankle weight set (they're like thin round cylinders so I can hide them in my shoes and DD bra size)... and I'm sure I'll have it. THANK YOU! I'm going to start a new thread when I return this afternoon and I'd love for Min Pin Mom to look at it if she can.

[mommyof5 0]

Today I was on the Tricare West website & I looked up coverage for this & this is what I got:

Gastric Bypass

TRICARE covers gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery) is covered only when the beneficiary meets one of the following conditions:

• Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints
  
• Is 200 percent or more over ideal weight for height and bone structure
  
• Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown)

TRICARE does not cover:

• Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction
  
• Biliopancreatic bypass, gastric bubble or balloon for the treatment of morbid obesity

Can someone correct me if I'm wrong, but I read here that Tricare covers both surgeries.....Gastric & Lapband????

[miissxangela 0]

yes, they cover both..from what I have read and heard