Will tricare approve me (comorbidities)?

[Allformyson 0]

I don't have full blown diabetes but I have pre-diabetes. I was on metformin until I got pregnant and then I was breastfeeding for a year and couldn't take the medications.

Now I am getting back on metformin and also cholesterol medication but I know high cholesterol isn't a comorbidity. I had gestational diabetes during pregnancy and was insulin dependant even though I followed the eating rules perfectly. My dad has diabetes and I'm sure I am headed that way eventually if I don't do something about it.

I have a feeling though I am going to get denied. Any thoughts?

[AmyUSMCwife 0]

What is your BMI and where are you located. If there is a MTF that dose Lapband all you need is your Dr to send a referal and BMI over 40. I have triwest my self. I have not been banded yet but I have got everything started.

[Allformyson 0]

I'm just under BMI 40. Weigh me in my clothes and I'm probably at 40.

I'm not near a MTF. I'm near Groton CT and was referred to Yale New Haven Hospital, which I haven't been seen there yet because I'm still working on my requirements and being held up by the long waits for appts.

[SpiritDriven71 1]

Now I am getting back on metformin and also cholesterol medication but I know high cholesterol isn't a comorbidity. ?

I would think hyperlipidemia would be considered one. did your doctor say this or Ins Co?

[ashgoodman 0]

I have Tricare Prime and I have been approved for my surgery Feb 12th...I am a diabetic and BMI is 37 and my cholesterol is slightly elevated so they considered me as having 2 comorbidities...Good Luck to you! I got my approval in 4 days once I met with the surgeon so Tricare is pretty quick and I think they are approving a lot more people now! Good Luck!

[help1977 0]

Tricare is great they don't make you go thru as much as other insurance company so your wait isn't as long plus you get your approval back in as little as 2 days. The biggest hold up for me is that my Dr is booked up until May so my date is not until May 19. Just make sure the letter your PCP writes he puts in everything that is going on with you that is a big thing with Tricare. Good Luck

[munger 0]

I was denied by Tricare twice! I figured out that the paper work was not complete. Your records must state that you are 100 pounds overweight - and they have to have you body frame in there - mine did not so I was denied. Remember it does not go by your BMI it goes by the MetLife weight scale for your body frame and height. The comorbities are pretty easy - if you have them and are on meds or special diet because of them - then they count. I just got approved and it took me 6 months!!!