start to end?

[babyka16 0]

hey everyone I'm new here! i just wanted to know if anyone is on tricare prime.( i have triwest) i went into see my PCM today and he said that i would be a good candidate to have the lap band done. so he put the referral in right there and then. the Q that i have is how long does it take for tricare to approve you to see the surgeon and then from there how long does it take to have the surgery? thanks so much for all your help:confused:

[RestlessMonkey 7]

Depends on many factors. I am tricare standard and it was 1 month from seminar to surgery. But you may have a busier surgeon, or tricare may be backlogged, or your psych consult write up may take longer etc. etc.

Your surgeon can give you a good "guesstimate" that will be most pertinent to your situation.

[babyka16 0]

thanks for the info! so if tricare approves me of the lap band. do i have to get approved again after i see the surgeon??? or is this first approval cover everything?

[RestlessMonkey 7]

I don't know about prime but my paperwork wasn't submitted until I'd had a psych consult a nutrition consult a meet w/surgeon and some blood work. Then it took 48 hours for tricare to approve it.

[Tina254 0]

babyka16 wrote: hey everyone I'm new here! i just wanted to know if anyone is on tricare prime.( i have triwest) i went into see my PCM today and he said that i would be a good candidate to have the lap band done. so he put the referral in right there and then. the Q that i have is how long does it take for tricare to approve you to see the surgeon and then from there how long does it take to have the surgery? thanks so much for all your help

Hi babyka16, I started a Thread to show my story and my process into getting the Lapband to help people that are just starting out at (http://www.lapbandtalk.com/f18/introducing-myself-my-story-so-far-98091/#post1276858). I've searched Lapbandtalk.com and other websites to try to find out as much info as I possibly can and I'm still confused sometimes, lol. I posted steps on how the process on my thread and I've also included it below. I hope this helps you and wishing you luck on your process. I also have tricare prime with triwest...

So for people who are just starting out I'll give you the rundown of what to do so far so your process will run more smoothly. **Remember: some doctors and different regions might run differently from mine but I'm sure the whole process is very similar (I have tricare prime with triwest)**

1.First: See if you fit tricare’s criteria for bariatric surgery...

TRICARE defines "morbid obesity" as meeting one of the following conditions:

a. The body weight is 100 pounds over the listed weight for height and bone structure (according to the most current Metropolitan Life Table) with one or more of the accompanying severe medical conditions which are diabetes mellitus, hypertension, cholecystitis, narcolepsy, pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints—conditions shown to have higher mortality rates when associated with morbid obesity

b. The body weight is 200 percent or more of listed weight range for height and bone structure (according to the most current Metropolitan Life Table) Example: if your ideal weight is 112 and your weight is 224 or more than you are 200% over your ideal weight.

In addition, TRICARE will cover the gastric banding surgery if a patient has had an intestinal bypass or other surgery for obesity and, because of complications, requires a second surgery.

**Note: Tricare does not require a 6 month diet plan but you primary care physician might require it before they will give you a referral**

2.Second: 1st If you haven’t already, sign up for your region’s online service so you can know if your referrals have been approved (I’m triwest so my website is triwest.com if you don’t know your region got to tricare.mil and find out). 2nd If you think you fit one or more of the above conditions for tricare, go to your primary care physician and ask for a referral to a lap band surgeon. Your best bet for getting the referral is to show and tell that you’ve tried everything to lose weight and have dealt with weight for many years (usually 5 years or more).

3. Third: When you get your referral and get approved for your first consult, which you can check online to see if your approved at triwest.com, make an appt with your surgeon of choice and print or bring the approval letter to your surgeon’s office when you go for your appt. **Some people have to see a base doctor for their surgery so you don’t have to wait for approval from tricare if you have a base doctor doing your surgery, you would have to wait for approval from the base doctor them self’s**

4. Forth: After/during making your appt make sure to ask what tests (blood tests) and classes (seminars, pshyc eval, ect.) do you have to have or can have done prior to your visit to your doctor so that after you see the doctor it won’t take longer to get approved for your surgery.

The blood tests usually include (some doctors might want more blood work done): CBC & differential count, CMP, TSH, and H-pylori blood test.

· A CBC is a complete blood count that is a series of lab tests that measure the amount, shapes, and sizes of red and white blood cells in a sample. The differential is a blood test that measures the different types of white blood cells and compares their amounts to the total count.

· The CMP is a comprehensive metabolic panel blood test that provides information about: how the kidney and liver are functioning, sugar (glucose) and Protein levels in the blood, and the body's electrolyte and Fluid balance.

· The THS is a thyroid stimulating hormone test that is a common blood test used to evaluate how well the thyroid gland is working.

· The H-pylori blood test tests are used to detect a Helicobacter pylori infection in the stomach and upper part of the small intestine. H. pylori can cause peptic ulcers; however, most people with H. pylori in their digestive systems do not develop ulcers. The Blood antibody test for H-pylori blood test checks to see whether your body has made antibodies to H. pylori bacteria. If you have antibodies to H. pylori in your blood, it means you either are currently infected or have been infected in the past.

5. Fifth: After your doctor’s office has all of your blood work, their required classes and evaluations in and you’ve been cleared by your surgeon as a good candidate for the surgery (which usually you will be cleared by your surgeon if you have a BMI of 35+ with a co-morbid OR have a BMI of 40+ and have been cleared by an nutritionist and physiatrist). The nurse or staff at your surgeon’s office will fax all the documentation to your insurance company (which would include your blood work, doctors notes, your comorbids (if any), weight, height, and bone structure, ect.)

6. Sixth: After your doctor’s office faxes your documentation to your insurance company the wait begins. For tricare I’ve heard all different things but most say they were approved within 24-48 hours. If you just can’t wait for a letter to come in the mail for your approval I would suggest to check online to see if you are approved (triwest.com or tricare.mil). If you see that you are denied don’t be alarmed just file a appeal. From what I’ve read most of the time the reason for denial’s are because your doctor’s office wrote down the wrong information (e.g. your weight is 250 but they put 225 or your height is 5’4 but they put down 5’7, ect.) or the doctor’s office left out information that is crucial to getting approved (e.g. They left out your weight or height, ect.). Just call tricare and ask why you were denied and have your surgeon’s office change what was wrong and re-fax it in to tricare and usually you will be approved if what was wrong was changed and it fit tricare’s conditions.

7. Seventh: After you get your approval your doctor’s office should get notification and so should you, either through the mail, a phone call, or you tricare region’s website. If you find out off the tricare’s website you most likely found out before your doctor’s office, I would suggest you call your doctor’s office and tell them so you can schedule your surgery. If you are anything like me when I get my letter of approval or see that I’m approved online I will first jump for joy and second call my doctors office to schedule my surgery, lol.

I’m probably leaving something’s out but this is an overview of what you will have to do in trying to get approved for the Lapband. I hope this helps some of you just starting this process. I’ve looked high and low and it is really hard to find a “one stop” list of “how to” on the lapband process with tricare. I will say again that some procedures are a little different according to what region you’re in with tricare, if you have a base hospital that does Lapband there, and if you have tricare standard instead of tricare prime. But overall the process is kind of the same and will at least give you an overall look at what you have in store. I’m by far not an expert on this but I’ve read and lerked around these and other forums to get informed on the subject. I’m still on step number 4(blood work)/6 but I’m just a little step closer to my goal. I’ve been dreaming of having this tool to help me change my life I’m hoping this is it for me! I’ll keep yall updated on my progress, and I hope this helps anyone considering this surgery. Much love for you guys, wish me luck!!! :smile:

[babyka16 0]

How funny! LOL i was just reading your post and repled to it thanks again