Talk to me about TriCare + Comorbidities

[tomatogirl 0]

Has anyone been approved with one comorbidity? My BMI is 46.6 and when my insurance paperwork was submitted, they accidently only listed one comorbidity. The doctor's office said, "well, it's done now, so let's see what happens." What are the chances that this will actually be approved? :redface:

[thatDEgirl 1]

To be honest, I am not sure what comorbids were listed on my paperwork. I was at a 41.1 BMI and the only comorbid I know of is high blood pressure. The surgery was recommended by my oncologist though, since I have leukemia so maybe that played a part?!

[tomatogirl 0]

Maybe. I guess I'll just have to see. I just keep hearing about the magical ~*2 comorbidities*~, so I'm nervous as all getup. <3

[Long2BFree 12]

I don't know how many were listed on my paperwork either but I was approved a couple of days after it was submitted. You might be able to log onto the website and find out if you've been approved already.

[JamieNP 20]

You only need one that they list in the handbook

[nic4483 0]

Does anyone know how long you have to have the co-morbidity for? I was denied by Tricare, but I'm preparing to appeal and just found out I have hypertension. So I should qualify now, but I'm just worried they might say I haven't had it long enough. I have the records from the dr. visit when I was diagnosed and it's noted that I was put on medication for hypertension. If anyone has any insight or experience I'd greatly appreciate it.

[mljalways 1]

Where can you see the handbook?

[tomatogirl 0]

The handbook says:

Obesity Treatment

TRICARE only covers morbid obesity surgery such as gastric bypass, gastric stapling and gastroplasty 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
  

TRICARE does not cover:

• Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction
  
• Biliopancreatic bypass, gastric bubble or balloon, or gastric wrapping for the treatment of morbid obesity
  

Ugh. We'll see. Although I might fall under the 200% rule. 200% would be twice your weight, no?

Edited September 9, 2008 by tomatogirl
200%??

[mljalways 1]

I am 5'7, weigh 240 and have diabetes mellitus and high blood pressure. I am a hoping!!!!!!!!!!!!!!!!!!!!!!!!!!!

[nic4483 0]

Does anyone know how long you have to have the co-morbidity for? I was denied by Tricare, but I'm preparing to appeal and just found out I have hypertension. So I should qualify now, but I'm just worried they might say I haven't had it long enough. I have the records from the dr. visit when I was diagnosed and it's noted that I was put on medication for hypertension. If anyone has any insight or experience I'd greatly appreciate it.

[tomatogirl 0]

I don't think there is a time stipulation on comorbidities.

[nic4483 0]

I can't seem to get a straight answer from anyone at Tricare if there is a time stipulation on co-morbidities. Anyone else have any experience or ever gotten a straight answer from Tricare?

[mljalways 1]

Not Yet but I should be submitting on the 29th and I will let you know.

[Long2BFree 12]

Have you tried going to your local Tricare office and let them get that answer for you? Maybe seeing someone face to face will pin them down so you can get the answer.

[mljalways 1]

Hey long, Did you use Tricare and if so was there any waiting period?