mommakatx2

Did they recently change their policy or something? Do have any copies of the policy you had been given or told before? I am right on the edge of qualifying for my insurance...it could really go either way. Yes, it scares me that I might go through hoops and emotional upheaval for nothing, but in the end I can't say I didn't try. And who knows? Maybe it will go through. I would still go ahead with your decision to pursue the lapband, if that's what you truly want. The worst they can say is no, right? And if that's the case at least you're no worse off than you are now. Yeah, it would suck, but at least you tried. Then of course there are always appeals and such. I've read several instances here where a person was intially denied but then they were approved through an appeal. Don't get discouraged, you don't have a rejection letter in-hand so you still have a chance! I say go for it!

Wendy~~That is just SO fabulous!! Congrats and hope you get your band date soon! Angela~~My PCM knew what physician to refer me to, but if yours doesn't then Tricare should figure that out for you. They will send you to surgeon in your area, though it may not be close. My surgeon is an hour away, but that's all they had around here. We are getting ready to PCS too, to Hawaii in May...I'm still going to try for it before we PCS though. My DH will also be deploying within 6 months and I'll have 3 kids...still going to try for it. Good luck with your decision and keep us posted!

wooooooooohooooooooooooo!!!!!!!!!!!!!!!!!!!!!!!! yeah!! That's Fabulous News Wendy!!!! congratulations And If You Wouldn't Mind Sharing...what Qualifications Did You Meet?? excellent News, I'm So Happy (and Jealous!) For You!!

Minpinmom, just wanted to say Good Luck to you!!!! I submitted my packet to the surgeons office today, which was the 2nd step I had to take, so I've got a while longer yet before I even get to the insurance submission. Keep us posted!!

If you search this forum you will see a 5 page thread on this topic. Just FYI

Hi Sgt. Bob! Good luck to you! It seems they are slooooooowly figuring this out. I have been on the phone for the last few days as well, and yesterday was the *first* time someone actually said "wait a minute...let's figure this out". Her name was Regina, and she was in Medical Management. Please keep us posted on your journey with Tricare, and I will do the same!

And here is a link to the Met Life Ideal Weight Chart: Met life ideal height weight tables references

I *finally* got through to someone today who actually did some research and discovered that it is indeed now a covered benefit. I don't know why I had such a hard time with that. Here is the policy that will tell you what the requirements are. It's a PDF file. http://manuals.tricare.osd.mil/index.cfm?fuseaction=TMAManuals.PVCSGetFile&PluginVersion=5&ReferenceManual=TP02&ReferenceChange=66&Type=ASOF&Manual=TP02&FileName=C4S13_2.PDF Good luck to everyone, and please...if you have already been approved please come back and tell us! I'd really like to know if Tricare is following those requirements to a "T" or if they are going on a case-by-case basis.

Yes, can those of you who have been approved please tell us what Tricare required? Not your surgeon, just Tricare. Please tell us your starting BMI and comorbidities, if any. Thanks and congratulations to all of you who have been successful!

mgordon, that's fabulous news! I'm thinking I won't be approved becasue I don't have any comormidities. My seminar is tomorrow and I'm excited, but no longer as hopeful. I talked with a rep from Tricare North today who said it's still NOT a covered benefit. I don't understand...how is that some of you are getting approved yet Tricare still thinks it isn't covered? Freakin' Tricare, is all I gotta say. Anyway, congratulations to everyone who's been approved, keep those of us still waiting updated on your process!

Thanks for the info. Can't wait!

THAT is FRIGGIN AWESOME!!!!! YEAH!!! :whoo: Congrats to you and thanks for sharing with us!!!! Here's hoping the rest of us can now follow suit.

My seminar is coming up...I was surprised that before you even get an appt. with the surgeon that we must attend this. Ok, no biggie...so what is it? Information only? Do they weigh you/measure you? Take a health history? I'm wondering what they could talk about for an hour??

I form awful keloid scars. I'm a little bit concerned about my laprascopic incisions when they heal. My cesarean scar looks awful, and even the tiniest scar looks terrible. Any suggestions for what I could do to minimize scarring? The OB who did my cesarean said she would do something special during suturing to help minimize keloids...but whatever it was didn't work. I'd like to hear from others who form keloids how they turned out and if you did anything special.

Wow. I am thinking the SAME exact thing you are! I feel like everyone will look at me and think--what the heck is *she* doing here? Well...I look at it this way...I'm headed in their direction, only I decided to get on the train a little bit earlier. If I think it's right for me and my surgeon thinks it's right for me...then who cares what other people think? And actually, I'm ok with people thinking "that skinny b*tch!" if they're going to. TOTALLY ok with that, lol!

Excellent news! Good luck mgordon1...keep us posted!

Jen, We live near an MTF (Fort Knox), however they do not do the lapband there. I will have to go to Louisville to have it done. Good luck with everything and keep us posted! Would be nice to have a Military BG if there isn't one already...

Thanks for the info Trell! I'm just on the borderline of a 40 BMI. Ugh. I do have arthritis and severe neck/back pain from large breats though. I guess I just won't know anything until I finish the seminar. Mine is on the 15th. This is such great news, anyway.

Thanks so much for clarifying! It sounds like you're on your way! I'm worried about the comorbidities, though. You can see my BMI in my siggie and I only have asthma and shortness of breath. I have painful joints but nothing I've been seeing anyone about (just twice in the last 3 years). According to policy, though, for gastric bypass surgery Tricare only requires you to be 100lbs over ideal weight with *one* comormidity. Good luck Yorkie and please keep us posted!

One more question...do you have an idea of what your out-of-pocket expense will be?

Whoa, whoa, whoa, Yorkie!! More details are needed! How did you get approved? May I ask what your BMI is? When did you start the process? Where are you located and where are you having your surgery? Sorry for all the questions but you're the first person I've ever heard of being approved by Tricare for the Lap-Band. I hope you don't mind sharing!

Do you really feel satiated and full after a very small amount of food? I have such a hard time believing this part...I don't know why. Maybe because I am so used to stuffing my face in order to get that "full" feeling. How long does it last? I am very excited about this journey but also somewhat skeptical of it as well...like many of you I've tried *everything*. Why should this work? Love to hear your experiences with it...

Good luck Trell! Let us know what you find out!

Actually my PCM approved my referral without checking the Tricare requirements at all. It's not their job to determine if you are eligible, that is the surgeons job. That is my understanding. Many times procedures are referred and approved on a case by base basis, even when there are "requirements". At this point, Tricare is not approving anything. It is my goal to complete all the necessary appointments and such so that when the date does come through all my surgeon has to do is submit the info. And, if all else fails...there's always Mexico :biggrin1:

You need to make an appointment with your PCM and ask them for a referral to see a bariatric surgeon. That will start you in the right direction. I don't think there is a discretion in whether you have Prime or Standard, so it most likely will not matter. Get the appointment and that will be your first step. Tricare still requires that referral in order to be seen by a surgeon. As far as the 5 year history goes, I think you're mistaking that for weight loss attempts--it's a 5 year history of being overweight, not dieting. Go for it! You've got nothing to lose by trying, and evenually it WILL be approved. Hopefully it will be soon!