Questions about Tricare

[bugginbri 0]

I am interested in what it takes to get Tricare to approve Lapand. I have scheduled my first appointment with my PCM on base. I am 100 lbs overweight and had Gestational Diabetes with my third and last pregnancy. I also have a huge family history of Diabetes. My mom just passed away at 54 years old from complications of diabetes. I just don't know if all of this will be enough to get approved. I know that Tricare requires a person to have some sort of health problems along with being 100 lbs overweight.

Does anyone have a similar experience? Can you tell me what I can expect to hear from either my PCM or Tricare? Also will I be referred to the HAWC before anything else?

Any help is greatly appreciated!:scared2:

[Ineedalapband 0]

From Tricares website:

• 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
  

[Kita 0]

WOW!! You sound exactly like me. I am an army wife...heres how it happend...i went in for my well exam...and they doc asked me what was the last Birth Control i was on...I told him the depo provera shot...he then asked me how much weight i gained from being on that....and belive me i had....it was 50 pds within a year. Mind you i wasnt a twig before that but i was about 175-180...im now at 230. He then came back and said that he wanted to recomend me for the Lap Band...and first i told him that i really didnt think it was for me. He said i understand but with your familys history of Diabites..( my mom and grandma and great grandma all have severe diabites that they developed in their 20's) that if i didnt lose at least 80 pds. within the next year i would most likely have it by then. I thought about it for a bit and told him that i thought it would be best. I do go to the gym quite often....and i try to eat as healthy as i can but it just wont come off. :scared2: I asked him why he recomended it to me...he said they will let anyone who is 100 pds or more over weight and has a BMI of 35-45, also history of diabites or other weight related issues get it. I suggest to you to make a Dr. Appt. maybe see if there is a doc that is more willing to refer you for it. Tri care will pay for everything....the trip cost and the procedure...its really amazing. I go for my meetings and everything Aug. 6th. I hope this helps you! Good Luck!:wink2:

[gina s. 0]

I have Tricare, and I had the surgery done.....I'm 5'7.5'', weighed 243, and my co-morbidity was diabetes. I wasn't diabetic yet, but I also had a strong family history of it. I had three high blood sugar readings, and then I asked my doctor if he thought this procedure would be good for me, and he agreed and sent a referral in to Tricare for me (my PCP is civilian). Tricare approved the consultation, but first I had to attend a seminar given by the bariatric center where I was going, then I had to have a psych eval (I self referred and Tricare covered that too) and then I had the consult with the bariatric center. The bariatric center then sent in the info on me, plus a letter of medical neccessity, to Tricare for surgery approval. I was approved, so then all I had to do was pre-op stuff and then get my surgery. But this is me, and I think different areas of Tricare do it differently. Plus I had to go through a civilian surgeon since this surgery isn't done on post. Anyway, good luck! Let us know how it goes.

[RaeShelle 0]

Kita,

It depends on witch Tricare you have. I have tricare Standard. I am also 100 lbs overweight, type 2 diabetic, high lipids, high blood pressure. also I am Adopted so i have no family history to go by for my health. My Dr. sent in everything to tricare and they said that I didn't need pre autherzation for Lap-Band becouse it was standard on my insurance. I would call tricare and make sure you are covered and have the doctor send everything in.

[amonroy 0]

I have tricare standard because I do not live close to a base at the moment. I was approved very quickly and had no problems whatsoever. I have worked in health insurance for the past 12 years so I know how the ropes go and I was expecting to have to jump through hoops but I definitley didn't. My first appointment with my physician was June 3rd and I had my surgery on July 16, 2008. The physicians office said tricare was one of the easiest insurances to deal with... Good Luck!

[seriousaboutit 0]

kita,

are you saying that you didnt have any "present" co mobilities? I just got denied by tricare cause I didnt have any but I do have a strong family history of heart disease, diabetes high blood presure and many other things...i would love to hear exactly how it went for you.

Raeshelle,

I have tricare standard as well are you saying that they denied you or that they said that you didnt have to get approval for the surgery and could just have it done and they would pay for it?

[bugginbri 0]

Thank you all for your thoughts and advise. I am hoping that the PCM that I will see is going to be the right person. It seems that it can go either way but that it depends alot on the PCM.