prettyCali916

Different hospitals are different. Some patients have to pay the deductible right before surgery. Others are just billed later after insurance settles. Some practices contact the insurance carrier to find out how much of the deductible has been met and then ask you to pay what's left at the time of surgery. It really depends. You should probably be proactive and ask just so you're not blindsided!

Oh and I track in myfitnesspal too! I love it!

Hi Nicole - Mine is 2/1. I don't have a preop diet but I am on shakes as much as possible. I initially wanted to do a complete Meal Replacement but I changed my mind to shakes as much as possible all last week. This week, starting today, I am on shakes for Breakfast and lunch, and then Protein and veggies for dinner. Hi February sleevers! 1 month until surgery and it's starting to seem real for me. I've been working on cutting out flour and sugar from my diet, getting into the habit of sipping Water all day long and eating on a schedule. I am quite a grazer and eat all day long so this is a big one for me. These are all things I have picked up from reading and listening to the advice of other patients who have had the surgery. My preop diet will start around January 19th I think. Just wondering who else is out there and how you're feeling about it? I'm feeling pretty good about it; I have been on complete shakes for a long time in the past. I am really excited to kick start weight loss and hope to lose at least 10 lbs (doc wants 16) before surgery. I am trying to get rid of some of my habits too. I'm not a grazer but there are other things I'm working on. I have already stopped drinking with my meals, I have made a conscious effort to chew each bite 20 times, I have been making the effort to take smaller bites, and I have been putting my fork down in between bites. I hope I can turn these into habits that will help later. Good luck!

Hi! Thank you! That's awesome! I hadn't been able to find anyone else who had/is used/using him! How was your surgery recovery? How did your sleeve hold up? Have you lost much? Did he have you do the milk of magnesia and Prilosec OTC before surgery too? He says that they will really help with how I feel afterwards. Thank so much!

My dr. doesn't do drains - luckily you don't have to go home with it. I'm just worried about lifting my 15 month old baby girl post-op. She loves for me to pick her up and I can't imagine her face when I tell her I can't. Luckily my husband will be off so he can out her in my arms but still...that's pretty much it.

I'm 2/1 and putting myself on a liquid diet. Surgeon didn't require one but he did ask me to lose about 16 pounds if I could so I'm doing that.

Sacramento here! Sleeve date - 2/1/16. So two weeks from now!!!! Anyone nearby? I'm going to be at CPMC in San Francisco and I'm just going that far because Dr. Jossart is AMAZING!!!

I think you're medication for weight loss meets the 4.1.2 requirement!

Oh - I was able to copy the email that Tricare sent me. Here it is: Aloha, Thank you for your question. The TRICARE Policy Manual does not specify a certain number of months that the beneficiary must have been unsuccessful under a supervised weight loss program, however, there a other clinical considerations that are provided as guidelines: TRICARE Policy Manual, Chapter 4, Section 13.2 states: __________________ 4.0 POLICY 4.1 Bariatric surgery, using a covered procedure outlined in paragraph 4.2 is covered for the treatment of morbid obesity when all the following conditions are met: 4.1.1 The patient has completed growth (18 years of age or documentation of completion of bone growth). 4.1.2 The patient has been previously unsuccessful with medical treatment for obesity. Failed attempts at non-surgical medical treatment for obesity must be documented in the patient's medical record. 4.1.2.1 Commercially available diet programs or plans, such as Weight Watchers®, Jenny Craig, or similar plans are acceptable methods of dietary management, if there is concurrent documentation of at least monthly clinical encounters with the physician. Note:These programs are not covered by TRICARE. 4.1.2.2 Physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement. 4.1.3 The patient has evidence of either of the following: •A body-mass index greater than or equal to 40 kg/m2. •A body-mass index of 35-39.9 kg/m2 with one clinically significant co-morbidity, including but not limited to, cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy, or pulmonary hypertension ___________________ Bariatric surgery for morbid obesity requires prior authorization from the managed care support contractor whose clinical reviewers ensure that TRICARE coverage criteria can be met based on accepted medical practice. I hope this information is helpful. Aloha, Gertie F TRICARE Regional Office West Hawaii Operations

If your BMI is under 40, Tricare needs proof of comorbidities like maybe diabetes, high blood pressure? I think they need two. It's on the Tricare page. When my doctor did my intake form he said that I was in pretty good health but that he was going to check the box for "joint pain and arthritis" because I dislocated my knee cap in 2012 and it was still bothering me. Other than that I didn't have any, however my BMI was 46. I'm very bottom heavy too. I wear a 18 in pants but a Large in tops. It's always been like that. My dresses are 16's because 18's would be so big on me up top so I just don't wear them anymore unless I wear thighs or leggings with them. I know you're struggle of being bottom heavy! You're so sweet Dawn! Thank you! I will definitely keep you posted! I'll add you as a friend on here - I think I have to go to my laptop to do that but I'll definitely keep in touch. My husband is active duty Air Force as well and we are in California. If he talked about your weight during those appointments it might work. If you can print out your weight watchers payments or even get them to give you your weigh-in history that might work if you were seeing the doctor and discussing weight during those times. If not, you might need to start now - meet with him and weigh in. Tell him what diet you're on - and then meet for two more months and do the same thing. They should take it based off of three months of dieting and medical supervision. I hope it works out for you! You have done everything else! I forgot about all the gyno stuff because mine was still current from last year. And you know what, if you want to try having the doctor submit what you've done it won't hurt, as long as you're ok with possibly being denied. You just have to make sure that if they do approve it you're ready mentally to handle the new way of life that comes from the sleeve.

Mine is on Feb 1st too!!!! My doctor doesn't require a pre-op diet - just Clear liquids the day before and no food from midnight BUT I want to be on a mostly liquid diet so I started substituting two meals with shakes last week. Starting Monday I might do completely shakes. Not sure. He said weighing less really helps and losing weight right before helps thin out the stomach which makes for better stitching. I'm very excited! Congratulations on getting your date!

The doctors office did try to say they weren't sure that my Optifast diet would work because it was only for 5 months and it was over two years ago (Jan 31 to Jun 6 of 2013) but I had sent Tricare an email because I wanted it in writing and they responded that there were no specifics pertaining to the duration or the timeline of the last weight loss attempt. You just have to have tried to lose. Doctors office submitted it on a Monday in the evening, Tricare reviewed it on that Tuesday and needed the doctor to clarify if it was inpatient or outpatient. They clarified and when I called Wednesday am it was approved.

It's so annoying because when I asked why the reps still say it's not covered, they said it's because they have to go off of what's on the Tricare.mil site. Until that site is updated, they will keep saying it's not covered! Your doctor just has to submit for it. It will come back approved if everything else is fine. If it is denied it will be for something other than "it's not a covered service".

No way!!!! Are you totally serious?!? I am so excited right now and such a feeling of relief! So they were right! Oh I want to kiss you! Lol. Do you know what their requirements are for it? What all do you have to do for them to cover it? Wahooooo!!!!???????????????????? Lol!!!! I am soooooo serious!!! You have to have something showing you tried weight loss before. They say Weight watchers is ok as long as you were going to the doctor and being weighed but if you have regular doctors appointments where you discussed weight and regular weigh ins, they'll take it! Plus all the stuff i said above!

My surgery date is 2/1. All they require is the psych eval, surgeons consult note and dietician's consult note. You won't get cleared by surgeon unless you have met the BMI requirements and have done all the tests (GI, labs, chest X-ray). You won't get cleared by the dietician unless you have proof that you have tried a non-surgical physician supervised attempt at weight loss in the past (I provided documentation of a liquid diet I did through Kaiser - optifast - in Jan 2013). Once you have all that, the doctors office needs to submit for the sleeve (as well as anything else you are considering). It will be approved. Do I need to take a picture of my auth letter????

I am getting the sleeve through Tricare. It is covered. I am going to a civilian doctor. When I called the patient rep said "oh you have Tricare - just so you know the doctor was just at a conference and they announced that they will now cover the sleeve so if you want it we will submit for it." They submitted for it and I got approved in 3 days! It's covered. I feel so bad for everyone stuck on the misinformation that the Tricare line is giving. It's covered! And not just at the MTF! I'm going a civilian Doctor who is in the Tricare network as a network provider.

Mine asked me to try to lose 5% by surgery date but then we sat and filled out my projected targets for 3 months, 6 months, 9 months and a year and he used two sets of numbers: one set was if I lost the 16lbs he wanted me to and the other was if I didn't. He said either way he'll do my surgery but that the more I lose before the better he can handle my stomach during surgery which makes for a better, tighter sleeve. And then he proceeded to not put me on a liquid diet or any pre op diet except for 2 days before surgery lol. So I've put myself on one. I had some optifast shakes so I'll be on total meal replacement until surgery on feb 1.

That's awesome!!!! I'm so excited for you! I like the rigidity. He's very strict on other areas. My post op diet is 2 weeks liquids and then two weeks soft. But even through maintenance my calories should only be 600 and 1000 max when I start working out. Excited!

I'm the Monday after on 2/1!!!! Good luck!

Hi Lindsey - I didn't have to do the 6 months; I had documentation from a 5 month liquid diet from Jan 2013 and that met the requirement. Tricare only requires a "documented attempt at weight loss" prior to the surgery. No duration and no timeline. Good luck and I hope it works out for you!

I know that if you have it done at a MTF it is free, but I don't have one near to me. So I would go to a hospital in my area and use a civilian surgeon as well. The tricare site still says it's not covered. I'm going to keep going with my process anyway, I know after 20yrs of being associated with the military, active duty and now a dependent I know updated info trickles in like icebergs. LOL Yep. I agree. Everything is so slow. I'm at Travis AFB and they would do it but I would never go to the MTF for anything. I see civilians for everything. Good luck with your process!

Oh my word...this...wow. I'm just so happy right now. I know it will be a process but just knowing I MAY be able to get the surgery makes me so relieved. I'm actually shaking. Thank you, thank you so much. The nearest MTF to me that does the surgery is 2hrs away and that's just not feasible for me and my family. Happy New Year ladies and gents Happy New Year!! I called last night and they are still saying it's not so I asked for a manager and she said she is aware that it is going through since the codes are updated in the system but that until the Tricare.mil page changes their information, they cannot say anything else to members. Which really sucks to be honest. People are walking around thinking it's not covered which is not cool. I am lucky that my doctor had just attended a conference and it was announced there that it was now covered (something about how Medicare now covers it so Tricare can now too - don't know how or why that's related but it is). Anyways, I'm so glad you are going to continue on with the process. I wish you the best!!!!

I'm Triwest - UnitedHealthcare Military West. Whoever you spoke with probably looked at the requirements online or something - your doctor needs to submit for it anyway. It will go through.

And you can call Tricare yourself as well, they told me the same thing. The girl that answered was actually in the process of prepping for the approval process for her own surgery too!

Hi! As of November this year Tricare is authorizing the sleeve. My surgeons office called to get my insurance info and was told the procedures that were covered but the sleeve wasn't mentioned. The rep told her to submit for it anyway because it was newly approved and that it is covered. My insurance packet was submitted for auth on 12/8/15 and 12/11/15 it was approved for the sleeve. I have no comorbidities, 42 bmi, and 5 months of optifast documentation from 2013 as my "documented attempt at prior weight loss". Tell your doctor's office that they are updating their information but to submit it anyways. Good luck!