Tricare coverage change

[BellaBean 0]

Did anyone else notice the recent change for Tricare coverage?!

I remember just months ago you had to have 2 comorbs to be approved. This helps my greatly since I only have one.

'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'

[thatDEgirl 1]

I just pulled out my article that was ran several months ago in our base paper and it only says 1 comorbid. I dunno...I only had 1 comorbid and was approved back in June.

[BellaBean 0]

Every time I looked it said 2 on the Tricare handbook website. Jeez and I thought I had some nice news to share, come to find out its old.

[thatDEgirl 1]

It may have, I am just telling you my experience.

[mljalways 1]

How long did it take you to get approved?? I am submitting Monday

[gina s. 0]

I only had 1 comorbid and was approved back in June.

I only had one, and I also got approved and had surgery in June. Through the whole process no one ever told me that I needed more than one.

[losing08 0]

I have none and was approved by Tricare. Was approved in 3 days back in May and had surgery in Aug. The only thing that i had was being 100lbs over weight.

I did hear from my dr that tricare is getting more tight on who they approve now.

[tutornmom 1]

My doctor's office staff said that Tricare says it takes 48 hours and it did for the office to hear and 3 days for me to hear. I wish you the best. This is the best thing I have ever done for myself. Thank you, LORD for opening these doors for me!

[allielee 263]

Bahh.. I was 100 pounds overweight with no co-morbids and was DENIED.. I ended up shelling out $18,500 and got it done.. it is so frustrating (for me) and happy (for you) to see approval with just overweight. Tricare approved me to get the bypass but not the lapband and my hubby said it was to risky thought $18,500 was easy to pay in exchange for risking death with bypass...

Has anyone heard of any of the military bases doing free plastic surgery ie tummy tucks? My hubby got a free vasectomy reversal couple of years ago.. wondering if they have any other free things..

[losing08 0]

Bahh.. I was 100 pounds overweight with no co-morbids and was DENIED.. I ended up shelling out $18,500 and got it done.. it is so frustrating (for me) and happy (for you) to see approval with just overweight. Tricare approved me to get the bypass but not the lapband and my hubby said it was to risky thought $18,500 was easy to pay in exchange for risking death with bypass...

Has anyone heard of any of the military bases doing free plastic surgery ie tummy tucks? My hubby got a free vasectomy reversal couple of years ago.. wondering if they have any other free things..

Im sorry tricare denied you and you had to self pay.

About plastics, my pcm told me that tricare will pay for anything i need when im ready for plastics.

[TROPICAL6 0]

How long did it take you to get approved?? I am submitting Monday

Last August, my doctor's office faxed the request, in the morning...that afternoon, Tricare called me to say I was approved. That was great service!!!

[sunsetskies 0]

When I started the process the very end of Sept. My PCM told me that Tricare in the past few months has changed the requirements for the lapband and it is so much easier to get it done now. I was approved the next day for my referal and had an apt with the nutritionalist on base that very next day as well.

From start to finish my surgeon required 6 week time frame, 2 nutritionalist apts... 1 psych eval and that was it. It was simple. He showed me a chart that they had from tricare and said even if he didn't count my co-morbidity of hypertension... I was still within tricares standards of being overweight... he had a scale that looked like a bmi chart.

This is how it all worked out for me......

~Sept. 22th - I had an apt with my PCP for blood pressure medication, asked about the lap band, she said that tricare just recently started covering it and she would put a referal in for me...

~Sept. 23th - the nutritionalist (Erin Wilson) on base called me the next day and said she had an apt available that day so I took it.

~Sept. 23th - saw nutritionalist who went over how I would be eatting before and after the surgery and gave me some literature on eating with the lap band.

~Oct. 1st - Saw Surgeon. I had a few issues with finding a Surgeon in the Corpus Christi area that was in the network, but finally found Dr. Griffin a general surgeon who is a bariatric surgeon as well. He said I needed to make an apt to see the nutritionalist one more time (total of 2 visits with her), have 6 weeks total wait before surgery, and a psychologist approval (he had a list of 2 of them in the area that were for Tricare) so i called for an apt.

~Oct. 27th - Saw my nutritionalist one more time to get my pre-op diet instructions. (Dr. agreed that I could follow the nutritionalist on bases diet)

~Oct. 27th - (same day as nutritionalist apt) Dr.'s office called to say I was approved with tricare (before i went to the counselor for approval lol.. that was weird)

~Oct. 30th - and then went to the counselor (Aurora Ortiz) who sat with me for 13 minutes and asked general questions about my family and the surgery, gave me an approval paper to give to my surgeon.

~Nov. 4th - went to see my surgeon last week for surgery day instructions and orders for the hospital to do my preop blood work, xrays, and get registered.

~Nov. 4th - went to hospital for pre-registration stuff. (blah took 3 hours of waiting around they were so busy)

~Nov. 10th!!!! - surgery is scheduled for Monday November 10th!!!

Edited November 6, 2008 by sunsetskies