Tricare bandsters? Help!!

[wyoming_mistress 0]

Ok, so this is my first post. My name is Stephanie, I am 20 years old married to a Navy Corpsman and I have two amazing little boys, one of which was born only 4 months ago. I am 5'3'' with a small frame and pushing 250 lbs! I am just sick of this weight, I know there is a skinnier, happier person inside of me just dying to get out! I would like to know what my chances are for getting approved for the surgery, how hard it is to get Tricare to comply, where I would go... just EVERYTHING! So if you guys could help me out I would be SO THANKFUL! I have scheduled my appointment with my doctor on Oct 26th to talk with him and try to get his OK for the surgery! Also, if you are a military spouse/retired whatever, I would love to hear your story!

[chatty826 4]

Hi,

So I was unhappy with my army doctor and found out I can see a civilian. I looked up one near me and covered by tricare (shes an ARNP). I also knew of a weight loss surgeon on the same medical group as her so that was my drive in getting in with a general practioner with this group. I saw her on my first visit talked about my health, birth control and said I wanted WLS. I told her I had a seminar scheduled and she was very supportive. She got me set up for a sleep anea study as I only had one other co morbid which was high blood pressue.

You can see my dates below but my process has been super smooth. I dont know how it is getting it done on post as I know some do it. For me I had Tricare approval the same day it was submitted by my doctors office and they even had a tricare nurse call to tell. I am sure this is the best decision of my life. I have paid no out of pocket costs and am on Tricare Prime West Region. I have had everything done but Psych eval which will be done tonight. Anyhow feel free to email with any questions and good luck!!

[milwif 0]

Hi!

I have Tricare Reserve Select in the West region. I first went to the seminar at the end of March 2009, and had my surgery Sept. 24, 2009. The only reason it took so long was because my surgeons office had a waiting list, Tricare was great and quick with all of my referrels and approval. I received my approval just 3 days after my surgeon submitted it.

I'm 5'2" and started at 235 lbs. and honestly I didn't really have any solid comorbs. I had joint and back pain, a slight form of sleep apnea called sleep hypopnea which most overweight people have anyways, and slightly elevated cholesterol. I didn't have a single comorb on Tricare's list of requirements....BUT...I did meet the criteria for 200% of my ideal weight range. And it looks like you do too, plus with your comorbs, I think you will have no issues at all getting approved. Good luck!:thumbup:

[wyoming_mistress 0]

Well.. I spoke with one of the nearest hospital that is a "Center of Excellence" that will do the surgery with Tricare Prime South Region... and she told me that everything is covered except for $1400 for a psych eval, a dietician consult for pre and post op.. and a weekend work shop and some other thing. I feel like I will be getting ripped off!!! My husband is only an E-5 and we have two little ones... I don't exactly have $1400 at my disposal! I am going to contact a MUCH closer facility and see what they have to say. I just feel like this is ridiculous!

Thank you for sharing your experiences with me! I have been so excited that I meet the criteria for this surgery.. it has been ALL that I have thought about ever since! I just hope it goes smoothly like y'alls.

[milwif 0]

Well.. I spoke with one of the nearest hospital that is a "Center of Excellence" that will do the surgery with Tricare Prime South Region... and she told me that everything is covered except for $1400 for a psych eval, a dietician consult for pre and post op.. and a weekend work shop and some other thing. I feel like I will be getting ripped off!!! My husband is only an E-5 and we have two little ones... I don't exactly have $1400 at my disposal! I am going to contact a MUCH closer facility and see what they have to say. I just feel like this is ridiculous!

Thank you for sharing your experiences with me! I have been so excited that I meet the criteria for this surgery.. it has been ALL that I have thought about ever since! I just hope it goes smoothly like y'alls.

Uh yeah that sounds like a rip off. Plus your psych eval should be completely covered. I did have to pay out of pocket for the two nutritional appts I've had, but together they only cost $170. I agree that you should look somewhere else. I hate when places are only out to get money...

[wyoming_mistress 0]

I could deal with $170.. $1400 is a little extreme! I am going to call the place that is closer tomorrow, hopefully it will be better news!!

Edited October 20, 2009 by SassyStephy

[Enchanted 2]

I don't have the same insurance, but my psych evaluation was not a covered expense - but the expense was only something like $100 - 125.

[YngGram 73]

You might be OK, the guidelines can be found online. I was 5'1 240lbs., but we are retired and I think that makes it harder. I had some comorbids, and a history of failed weight loss attemps. My process went smoothly, and was covered 75% for me, non-network facility. Pretesting was covered as any of my other medical care. The Center of Excellence I used included my nut. classes, and was will to set up all the test I needed. I didn't use that because I live over an hour away.

First appt. was Nov. 17, 09 did the testing around the holidays. Submitted to TriCare in Jan. and got approval in just over a week. The big waiting was the doctor's scheduling. I don't have problems getting my follow ups though.

[MrsMAJL 0]

I have Tricare Prime and I didn't have to pay anything out of pocket (surgery was done off post). I also didn't have to have a psych eval. My approval came very quickly, 6 days from a visit to my primary to approval, and I had surgery less than 2 months after my talk with my primary. I have done really well and have been at goal for about 3 months now (had surgery 4/18/08 and lost 160). I just had a panniculectomy a month ago and that was covered 100% as well, but I also had to have my port repositioned so it was done at the same time.

I saw that someone that replied was in Lakewood, WA, I'm in Puyallup. We should get together sometime. Feel free to send me an email off of LBT at ALionberge@aol.com

[Electrawoman 5]

I have Tricare Standard and I am just now researching the process for banding and trying to make a decision. SO, I don't have a lot of info on Tricare except for what it provided in their literature. But regarding the 1400 psych eval, etc., this is extortion. I used to work in the medical field and I will tell ya'll this. You can negotiate all charges and you should. The bottom line is this, the doctor and surgeons want your insurance money more than they want your copays and co-insurances. If they think you are going to bail because their prices are too high, they will make adjustments pretty quick.

[carolynfletcher 0]

Well.. I spoke with one of the nearest hospital that is a "Center of Excellence" that will do the surgery with Tricare Prime South Region... and she told me that everything is covered except for $1400 for a psych eval, a dietician consult for pre and post op.. and a weekend work shop and some other thing. I feel like I will be getting ripped off!!! My husband is only an E-5 and we have two little ones... I don't exactly have $1400 at my disposal! I am going to contact a MUCH closer facility and see what they have to say. I just feel like this is ridiculous!

Thank you for sharing your experiences with me! I have been so excited that I meet the criteria for this surgery.. it has been ALL that I have thought about ever since! I just hope it goes smoothly like y'alls.

I think you are getting ripped off also. I have TRI PRIME my husband is retired AIR FORCE. I had to pay $350. for something I forget what for, but my nutritionst met with me in my surgeons office @ $12 copay. my pcyh (don't know how to spell it:) I had to pay $100 up front but he summited to ins and I got it all back. My fills are done with the xray at $250. a pop and I pay $12 copay for that. So check out some more places. good luck