Tricare Prime Arthriitis and Diabetes

genevievenc · April 12, 2009

This is my first time posting, and recently I've decided the lap band might be my best option.

A year and 1/2 ago I was on my way to losing weight after having a baby. I went from 230 to 179. I tore my meniscus working out. X-rays revealed I had degenerative arthritis so my doctor did not send me to an orthopedic surgeon immediately. You can't see a torn meniscus on x-ray. He basically told me take ibuprofen. Needless to say my meniscus was torn six months before I had surgery. In any case, it's been a year since my surgery and my knee has never been the same.

I was able to maintain my weight for a year but recently I gained 15 pounds a couple of months ago, and another 15 for a total of 30 pounds in 3 months. To make matters worse I am pretty sure I tore my other meniscus last month. I've been hoping it will heal, but it's not happening.

Up until last year, I have always been able to work out to lose weight, although I have always had a few extra pounds after having children, but I've always been ok with that. Now I can't even work out anymore (ex. treadmill, lunges, elliptical) and I feel horribly stuck. I am going to get a referral for physical therapy to try to get my knees to as normal as I can. I think at this point, I have fought the good fight, and now I am seriously considering this surgery.

Right now I weigh 214 (BMI 36) and to be considered for surgery with tricare prime I need to be at 227 (I am 5' 5".) At the rate I am going the few extra pounds is nothing.

This is my question. According to tricare, one criteria is to have severe arthritis. How does one figure what severe arthritis is? I have x-rays with degenerative arthritis in my right knee, and I probably have it in my left. As I understand arthritis does not always show on x-rays. If it shows on an x-ray would this meet the severe arthritis criteria?

I may be very close to being diabetic or possibly having it at this point with how much weight I have gained. I had gestational diabetes when I was pregnant. Having gestational diabetes is a indicator you will have diabetes at some point in your life, does tricare take this into account?

Thank you in advance :thumbdown:

Edited April 12, 2009 by genevievenc

Vickie · April 13, 2009

I have arthritis in both my knees and back and I only weighed 186. My doctor told me the only way to lose the pain was to lose 60 pounds which would put me at 126 and pain free. There is no way my insurance would pay for it so I went to TJ Mexico and had my done. I had this done in Dec. and I'm slowly losing the weight,24.2 pounds and only about 36 more pounds to go and maybe I won't have to have knee or back surgery. Go to Mexico and spend the best 7,000 you have ever spent and forget the stupid insurance.