Will I get approved through Tricare?

[milwif 0]

Alrighty so I tried asking my NP if she thought I had a decent chance of getting approved through tricare(triwest) with my stats and she was no help at all! So I thought I'd ask you fine people your opinions. Be honest...

I'm 21, been overweight all my life. 5'2" 235 pounds, small framed. My comorbs include elevated cholesterol, back and joint pain, skin sores, and sleep hypopneas(not apnea.) Unfortunately I don't have their exact list of comorbs thats my biggest worry. However since I'm small framed I can maybe squeeze into the 200% over my ideal weight catergory, depending on how Tricare sees it. So anyways, I'd greatly appreciate all your guys' input. I've heard lots of different things about Tricare, some say they're picky, some say they had no problems!

[talkalot1981 5]

Hello, well I have Triwest as well. I am 5'4" 249 lbs. I got approved with having 1 co-morbity, high bloop pressure. Well actually I had to gain 6 lbs and ended up gaining 11 12 by accident.:thumbdown: Tricare usually only goes by the med frame stats on the Met life table. So you might want your surgeon to specify that you are small framed. Even with the small frame using the 200% you need to be 242. They use the highest number. If you are small frame and have 1 co-morbity then you will need to be 229. If you have no co-morbities, then you might want to stuff your pockets with some weights. lol eat a real big and salty meal the night before and the day of. And go with a full bladder... I dunno if this helped but if you have any other questions just let me know.... Jennifer

[milwif 0]

Thanks for the tips:smile2: Unfortunately I've already done my official weigh in for the surgeon, and i'm stuck at 235. I guess now all I can do is pray and cross my fingers.

[talkalot1981 5]

Well you can alway appeal if you get denied. When you appeal they have to submit the paperwork all over again and that gives you a chance of using a different weight... But you never know, like you said just keep your fingers crossed and hope for the best.. Jennifer

[Lilpeach_059 0]

Im under 25 also, and I kept calling Tricare (South) and asking which height/weight chart were they going to use to determine my "ideal weight," since the one online is for people 25 and up. I dont know if this helped...and also my packet had 3 different weights and 2 different heights!! (5'5 and 231 lbs, 5'5 and 253~lbs and 5'4 &1/2 and 241lbs)

To get to 253 I used anke weights

To get to 241 the nurse asst "made an error" (she was so nice)

To get my height at 5 4&1/2 (I told them I wasnt 5'5!)

Im really 5'5 231lbs

With Tricare Prime you have to go see your PCM before you can go to a specialist and my PCM weighed me twice, and the surgeon once...so thats how I got 3 diff weights.

Also, I would have the surgeon and PCM (if applicable) to write a letter with all the comorbities and hopefully they will misread and think you have sleep apnea!

I had 2 letters from my PCM, one had my co-morbities as joint pain, asthma and recurrent skin abcess. but everytime I called Tricare- they stressed that if the surgeon deems the surgery medically necessary then they will likely approve it.

Another thought...have you tried going on base?

[milwif 0]

Thanks Peach! I've thought about talking to my nurse practitioner and seeing if she would make a little "error" on my weight, maybe be temporarily dislexic and make 235 into 253. But I don't think she'd go for it, my hospital is also a university and they are all about accuracy (I just had my 11th preop appointment/test this morning!) I have thought about going on base but I'm not exactly sure if I can have it done there, my husband is National Guard and he's not currently on Active duty orders. I don't know if that makes a difference or not.