Tricare Prime / Triwest MTF - steps to take?

[justmee 0]

Hello, I am new to this forum so bear with me. :cursing:

I am Tricare Prime (TriWest), assigned to an MTF. Does anyone know what steps need to be accomplished to get approval for Lapband?

I am at a BMI of 40. I have talked about this several times w/my PCM prior to it being a covered procedure. Once I found out it was covered I talked to her on the phone and she put in some referrals. I can't into an actual appointment w/ PCM until the end of the month.

I have referrals in place and appointments with right now:

Nutrition

Psychiatry

General Surgery

and I am registered for 2 "Therapeutic Lifestyle Change" classes

But my referral to Case Management was denied as "more information needed".

So my question is: For those who have been Prime, assigned to a MTF, looking to be banded at an MTF......what steps did you have to take? What was your experience? Does the General Surg make the decision? Does it not bode well that my referral to Case Management was denied? (PCM is trying to find out what more is needed)

Thanks in advance....:drool:

[Tantrica 0]

I'm not much help with having the surgery at a MTF, I elected to go to an in-network provider off post due to the lack of qualified surgeons on base. BUT I had no trouble once my referral was in place. TriCare doesn't require the life style classes for approval and they do not offer them here so I didn't have to go to them. I did have a psych eval done off post, not a full work up, just a 1 hour interview with the psych to be sure I was capable of making the decision, a nutrition consult to learn what to eat, upper GI, abdominal U/S, chest x-ray, liver function test, labs, and a pulmonary function test, and a 12 lead EKG. I'm not sure what the case management thing is either, lol. I simply saw the surgeon, had the required tests and had the results submitted to him. He is reviewing them as we speak and will be submitting to TriCare for approval this week. I'll let you know how it goes from there!

BTW, I'm 5'6", 245lbs, BMI 40.8

Kari

[miissxangela 0]

Hi... I have tricare prime north and WAS looking to be banded at a MTF but there is a 6 month wait! ... Anyway, I had to go to my PCM, get a referral which got sent to the MTF, then I had to go to a mandatory 4 hour seminar. They explained that they would call us and schedule an appointment for a consultation with the surgeon and from there the surgeon would decide if he wanted to operate, submit it to tricare and wait for the approval. After approved, I would have to attend a 1 hr appt. with the psychologist and nutritionists that are on base. After that I believe I would meet with the surgeon again and set up a surgery date..and i think thats all I know haha. Since there is such a long waiting list I am jumping through hoops to get treated by a civilian surgeon. Keep your fingers crossed!

[4Aria 0]

Hello everyone.

I am new to the forum and have been looking around regarding info on banding / surgery and the process one must go through with Tricare prime.

My PCM actually suggested I need surgery ( however thats what I was leading up to on that visit) I had to go to the HAWC ( health and wellness center) and set up nutrition classes ...was told that I will have to do that for 6 months!!

Thats a long wait...is there a way to expedite the process? What else will I have to have done before finally have the procedure?

Just to introduce myself...My name is Lori

Im 5'5 285 pounds and have a beautiful baby girl. Shes 5 months old and my motivation for change.

[justmee 0]

The steps I have had to take so far:

I had to get approval for a case manager. She will be the one helping to co-ordinate all my other appointments. I meet face-to-face with her on the 18th.

I have had to register for 4 "Therapeutic Lifestyle Change" classes. (Note that is up from the 2 classes I was originally told)

I have to see a nutritionist every 3-4 weeks to monitor my progress on a low-calorie/high Protein diet. I have to attend monthly bariatric surgery support group meetings. I was started on my "pre-op" Vitamin and beginning Protein shake regimen. (40g of Protein in supplement form every day) This will continue for approximatly 6 months. It can go faster depending on when the caseworker and nutritionist think I am ready to move on. I was also warned that they have kept others in this "limbo" for over a year.

I am also going to have to meet with the psychiatrist at my MTF and undergo a couple personality tests.

I meet with the surgeon on the 25th to discuss the surgery and weather I am a good choice for Lap-Band or if traditional by-pass is the better choice. (If they won't do the Lap-band, I am really not sure where to go from here because I don't like the idea of a bypass.)

So this is where I am sitting with what needs to be done for Tricare Prime to be banded at a MTF. I can't help but wonder if each MTF comes up with it's own hoops that we must jump through.

Anyone else banded/going to be banded at a MTF? What was your experience?:confused2:

[munger 0]

I think they do come up with their own obstacle course!! I had a friend in GA - she asked, when to a phys. eval and was baned with in a month!! Our BMI and comorbities were the same and I got denied!!!