Tri-Care

[BroncosGalAndrea 0]

Did everyone here have (or going to have) their surgery covered by Tricare? When I read that they were finally covering the lap band procedure, i jumped on it! It was the easiest process I've ever had to go through with them. In fact, my surgeon's office told me tri care was the easiest insurance they've ever had to deal with. I had my procedure scheduled and done within around 6 weeks of my initial consult - psych and nutritionist appts included! :party:

[JamieNP 20]

I have Tricare prime and my appointment with the surgeon is in one week. I am on the borderline of getting approved (the 100 lb overweight thing...I have the comorbidities). I have heard nothing but good things about Tricare and how fast they are.

[armywife4life 0]

I had to battle my PCM a lil, he was kinda gun shy, but once he gave me the referrel, it took 2 hours for tricare overseas to approve the consultation with the surgeon and 1 week to approve the actual surgery. I did my psych eval it was like 15 min, he just wanted to check make sure i knew that if i lost weight it wouldn't make life magically great. LOL. I had labs done, and that is where i got my co-morbs from they really really sucked. plus i hit the 40 bmi. I did all my ekg, upper gi, the night before the surgery at the hospital where i was having the band done. easy peasy honestly, once i committed it probably took 2 mths from start to finish. Thank you Tri care!!

[mphsmommy 0]

I have Tricare and don't think I'll have a problem getting approved. I am over the 100lb over quota and they are doing several surgeries a week here on base. I hope to have my surgery at the end of August or first of Sept.. I'm currently waiting for our Biariactric Nurse to call in our stats to the Lab, Nutritionist, and Pshy. so I can call and make my appointments for them. I had my consult with the surgeon last Monday and she still hasn't done it. I'm probably going to go talk to her tomorrow to see what the hold up is.

[gina s. 0]

I had Tricare Prime too, and it was pretty easy. I wasn't sure if I hit the 100 lb. overweight mark either, but I guess they thought I did!

[thatDEgirl 1]

I have Tricare Prime South and it was less than 2 months from PCM visit to banding next week. That was even with a 3 week hold up with the PCM (not Tricare).

[armywife4life 0]

:thumbup:go tricare!!!

[Insky67 2]

Tricare Prime South here. I had no problem getting approval but on surgery day my surgeon did tell me I was the LAST Tricare patient they would see...she said Tricare didn't pay much and that she was getting more money than the hospital. I guess the hospital had to eat a lot of the costs. Like they don't charge too much to begin with...ya know?

I guess I am lucky I got in when I did.

[eazes 0]

My surgery and all my pre appointments are covered fully by TriCare.

[browneyes1997 0]

I am not sure if this will be approved or not. I am not sure I am understanding the whole process with Tricare. I had the approval for the Dr. visits, I am 38% body fat, I am on the CPap (very sexy). I am "only" 85-90lbs overweight. But will they approve and then the Dr office said it take 45 days to get approval, but the Dr said it is possible to have the procedure before our co pays reset in Oct. I guess I am just looking for a sounding board.:drool:

[Insky67 2]

I had heard tricare will pay if you are 75 pounds over weight with comorbidities. I would say you have a very good chance for approval. You can log into the tricare web site and check the status of your requests...

[gina s. 0]

I had heard tricare will pay if you are 75 pounds over weight with comorbidities. I would say you have a very good chance for approval. You can log into the tricare web site and check the status of your requests...

I don't think that's right (unless they have recently changed something) because I read the guidelines and they specifically say 100lbs. overweight with co-morbity or 200% over ideal body weight with no co-morbidity. I know someone who got denied by Tricare in March because she was only 97 lbs. overweight and not 100, but she gained a few pounds and appealed it and finally got approved.

Edited July 20, 2008 by gina s.

[JamieNP 20]

Browneyes, I am in the same boat. My surgeon's visit is Monday. Since that time I have been eating everything in site to gain that extra weight to qualify (at first I started LOOSING weight!!!).

I am now just at the low end of the chart.

Weight-222 lbs (I will gain weight by Monday!!)

Ht 5'5

Sleep Apnea -on cpap

High Blood pressure

Had PCOS- But I had a hysterectomy because of endometriosis

Knee and joint pain

Family history of Diabetes, Coronary artery Disease, Obesity, Myocardial Infarction (heart attack), Rheumatoid Arthritis

My PCP has given me the referral, my Pulmonologist said he will write up anything I need, I have gone to numerous "diet doctors" so I have the diet history.

While you are waiting to get the referral, type up your medical history, your family history, all of the meds you are on, all of the diet programs you have been on, your weight history, the work out programs you have been on, type and paste Tricare's requirements from the handbook, and type and paste the metlife weight chart. Put anything and everything in there that you may think is important. Hand it to your pcp when you go, and give a copy to your surgeon, and psy doc. They will be quite impressed that you are so organized . If you need a copy for an example, pm me.

I will let you know Monday how it goes ( I have a different primary insurance that will have to deny it first before Tricare gets it so it may take a few days to find out)

Good luck and just go for it.

[browneyes1997 0]

Thank you so much. It is sooo wonderful to have a community that can understand the ups and downs of this process, please let me know how it goes Monday.

[armywife4life 0]

go for it brown eyes, and jwrn way to be organized and kickin butt girl!!