Tricare

[MaggiesMom1999 0]

I have Tricare Prime, south region. I went to the seminar at the end of February and had my first appointment with the surgeon in March. I filled out my part of the paperwork (weight loss attempts, etc.) and had my doctor send in my records and FINALLY got the surgeon's office to send in the paperwork to Tricare in late April. Approval was on line in about a week from the time they mailed it. But I needed to lose more than 150 pounds, have diabetes, high blood pressure, high cholesterol and have had two spinal surgeries so I had plenty of comorbidities. Had my pre-op surgeon visit and GOAL class on 6/6 and scheduled surgery for 7/01. I did not have any psych eval, no EGD, just the regular pre-op blood, urine, EKG and chest xray. Started pre-op liquid diet on 6/21 and had lost 24 pounds by 7/01, day of surgery! First check-up was 07/10. First fill was 8/08 and he put 3.5cc in 10cc band. Have lost 43 pounds as of today (8.5 weeks since beginning liquid diet for pre-op). Tricare has been great, no problems. I had to pay the hospital $25 and pay my $12 copay for each office visit. However, my surgeon's office told me that Tricare will NOT pay for fills and I had to prepay for 6 of them ($600) prior to the surgery. So my visit on 8/08 was the first of $100 visits. If anyone can cite "chapter and verse" where I can find indication that Tricare DOES pay for fills, I would love to see it.

Oh, I forgot to mention that I have not had a blood pressure pill or an insulin injection or diabetes pill since the day of my surgery! All under control! :smile2:

Leigh

Dr. Snow / Mobile, Alabama

320 / 296 / 277 / 170

highest / day of surgery / current / goal

[jennybyars2003 0]

Ok. I went to my PCM and she referred me to a weight loss specialist for the lapband. I went for my first appointment on Wednesday. I am so scared that I am not going to get approved.

These are my stats:

Height: 5' 3''

Weight: 226

BMI: 40.1

Medical conditions: Depression, PCOS & GERD.

I don't think that any of those are the medical conditions that they state that you must have.

My doctor said that Tricare has a thing where the patient has to be 100 pounds over weight. I am wondering if any of you have any advice or any dealing with Tricare.

I had to pay 200 dollars yesterday. I have a physc.. appoint on the 3 of sept. which is 65.00 and then I have a nutricianist appointment that is 100.00 and also alot of blood work and then they will send in the paperwork to Tricare to see if my package gets approved.

Does anyone have any advice for me..??

I am so ready for a life style change ...

Jenny

[RestlessMonkey 7]

Per insurance tables, aren't you 100 pounds overweight? Old rule of thumb was 100 pounds for 5' and then 5 pounds for each inch over ...

so you "should" weigh 115.

Did Tricare SAY you needed more comorbidities or are you just worried?

I'd call them and ask...not that you can always get the info you need.

It matters too if you are tricare prime or tricare standard.

[jennybyars2003 0]

My husband is Active Duty and I am Tricare Prime. Yeh I am 100 pounds over, but the LapBand doctor said I might have a problem b/c I am not over the 100 pounds limit. I don't know.. The last time I checked my ideal body weight was like 115- 125. I think I will just call them on Monday. I think I am just worried, Cause this is something that I want SO bad. I have looked up everything on the computer and I just don't really understand the whole process. I guess I just wanted someone to break all the lingo down for me...

I am just nervous I think.. and confused.

[pmcfarm 0]

jennybyars2003...you said you are active duty (? dependent). Your psych, dietary, labs you should be able to do at your base med facility.MC

[jennybyars2003 0]

yeh that is what my husband said: I am going to try and look into that tomorrow. I just don't know who to call.?? I guess just the tricare number.?

[Maggies 0]

I had my appt. with the surgeon today for the group meeting and then my appt. by myself. I only have one more test to be done and then they are going to submit to Tricare for APPROVAL. He said if approved I should be able to be banded by the first of October. I am just going to think positive thoughts. Does anyone know if Tricare requires a six month recorded diet before approval. I don't think they do, just wondering. Good luck to everyone.

Karina, How are things going with you. Keep trying you will prevail.

Maggie:cool2:

[aculberg 0]

No, Tricare doesnt require the 6 month diet...but alot of ins companies do! Good luck!

[aculberg 0]

My husband is Active Duty and I am Tricare Prime. Yeh I am 100 pounds over, but the LapBand doctor said I might have a problem b/c I am not over the 100 pounds limit. I don't know.. The last time I checked my ideal body weight was like 115- 125. I think I will just call them on Monday. I think I am just worried, Cause this is something that I want SO bad. I have looked up everything on the computer and I just don't really understand the whole process. I guess I just wanted someone to break all the lingo down for me...

I am just nervous I think.. and confused.

The process is actually pretty easy, but can be soo complicated at the same time!

1. Get the referral from your pcm to see a surgeon.

2. See the surgeon for an initial consult, he or she will weigh you and have you start all the process for your insurance, and order any tests that they will need. Tricare only requires that you be over 100 lbs according to the MetLife Ins table, and have at least one co-morbidity, like diabetes, hypertension, sleep apnea, and at least one other one, I cant remember!

3. Like you said, you'll need to see the dietician, have a psych consult, which Tricare will pay for IF you see a participating provider, have a surgical physical and bloodwork, and that can all be done on base.

4. Once you get all that done, your surgeon's office will submit the whole package on to Tricare. In my opinion, its all a matter of who's desk your info lands on, and how picky they are, as to whether you get approved or not!

My best advice to you on this subject is, keep on top of the docs, keep copies of EVERYTHING, including your medical records, and make sure the surgeons office knows everything so they can submit it with your package. The more info the better! And stay on top of them! lol

If you have any more questions, feel free to ask, I'll help any way I can!

Best of luck.

[Maggies 0]

aculberg, thanks for the info. Hopefully I will be having my surgery a week or so after yours. Going to Disneyland the middle of Sept, so not possible then. Does your surgeon require a preop diet? Maggie:cool2:

[yomoma 0]

i have the same problem did you get approved by now thanks

[thatDEgirl 1]

My timeline is here, if anyone wants to see it (it also shows my weight, BMI, comorbids, etc). It's just easier than typing it out all the time.

Life With Da Band | this life of mine

[AshleyBlue 0]

Ok so I have been to the doc and had my blood sugar tested not diabetic (a good thing ) I may have a problem with my thyroid I have to have more tests however I am not sure if that is a covered problem and do you have to be on medication for it or just diagnoised with it. My BMI is 41.6 and I had gallbladder surgery about four years ago and of course back and knee pain but I don't have any problems that tricare seems to consider a covered co morbidity. I had to change my PCM because we just keep butting heads ( she apparently doesn't feel that need to do her job ) anyway I was five minutes late for last appointment so she refused to see me but anyway does anyone have any suggestions please. I am really desperate for help.

Thanks

[Mimilou2004 13]

Jenny, I gained 10 pounds on purpose to make the 100 pound requirement. I also shrunk an inch, LOL.

[jennybyars2003 0]

i think that is what i am going to have to do too. LOL.