military insurance?

[southern_girl 0]

does anyone know anything about tricare? My husband is active duty and the website says that you have to be 100lbs overweight and have diabetes or some other syndrome. well, I am just overweight. I am 5"4 and I weigh 230lbs. I am at a point where I don't want to get any bigger. I have tried diets and exercise but they didn't work. I was just wondering (if anybody knows) what my chances are of getting a referral to get the surgery with just being severly overweight...

Thanks for any comments!

Kim:tongue2:

[Long2BFree 12]

My DH is also AD and I have Tricare Standard. This is the information off of the Tricare website about Lap-Band. You can also call their toll free number and speak with someone. They are very nice and helpful.

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)
  

[grammylew 0]

Good luck, my DH is retired and I have TriCare standard. I was 100 pounds overweight, but had no co-morbidities. I went to Mexico. My husband has Medicare and TriCare For Life and is just starting the process to get approved for this surgery. Seems to me more insurance companies would want us to be proactive with this. Why wait until we have those co-morbs and have done the yo-yo thing for years, and cost them thousands more in health care costs!?! Maybe in a few years they'll come around. Good luck! I hope you can get approved.

[angelface 1]

Grammylew. Did you go to Mexico and pay "out of Pocket" ?

[grammylew 0]

Yep. Tijuana, Dr. Ortiz, $8500, my daughter paid for it. Consequently if I have complications I would also have to pay for it myself, either here or in Mexico. I get fills at Fill Centers USA.

[bama_belle 0]

I just found out late January that since my hsuband is retired Army we are eligible for Tricare Prime which pays almost all of the bills for the surgery. You still have to meet their eligibility requirements and you have to go to one of the doctors on their eligible list, but thankfully mine is. You might check it out and see if you are eligibile for the Tricare Prime. BTW. it was only $115 per quarter to upgrade the insurance.

[ron lindsay 0]

I am retired Af. I have TRI CARE PRIME. I was banded on Feb 11 08. My portion of the surgery was $12.00. You really need your military dr to give you a strong referal, to make it easier.

[minpinmom 2]

Check out the Insurance forum on here - we Tricare people have been posting like maniacs since it became an approved procedure. You may find some of your answers! Good Luck and keep us updated!

[AvasMom 0]

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!:frown:

[jdmerck 0]

My DH is Navy retired and i have Tricare prime and was approved right away, no fight involved, nothing i had to do extra just a pych eval thats it..i have nothing but luck so far with it i meet the BMI of 40 i also have high BP, high cholest, very bad back...