Hello everyone,

I have Tricare Prime North Region. My BMI is 45 and I am 200% over my ideal body weight for my frame. I have no comorbidities, but everyone over the age of thirty in my family has high blood pressure and diabetes and is morbidly obese. I am 25 and realize that it is just a matter of time before these health problems touch me as well. I live in North Carolina and am being seen by Dr. Johnson at Carolina Surgical Associates in Morehead City, NC. I thought being 200% over my ideal body weight was enough, but my doctors office said that I need to be at least 100lbs overweight for the last 3 years for tricare to approve the surgery. I have only been 100lbs overweight for two years. I have not heard anyone else talk about this requirement and a time limit is not mentioned on the tricare website. Has anyone else run into this time limit problem with tricare?

Thanks

I can't imagine them charging 47,000 for the surgery when the average is 16,000 to 20,000. Sounds like a doctor's office trying to rip off the insurance company.

When my hospital billed Tricare for my surgery, which included repairing a ventral hernia and a hiatal hernia during the surgery, the total was more than $74,000. I about fell out of my chair when I saw that. But I monitored the Tricare website, and eventually saw that Tricare only paid them about $12,000. There's a reason to make very sure the hospital takes Tricare insurance before having this surgery - Nobody wants to pay the unpaid difference!

In my case, my total out of pocket costs, including the hospital stay and office visit copays, has been only about $100. That's a far cry from the $74K originally billed. Have I mentioned I like having Tricare Prime as my insurance?

Dave

Tricare prime is the BOMB! The process was easy and smooth.

When I first talked to my pcm about lap band, he told me he didnt think I would get approved........1 month later I had my surgery date!

It's been a year and a half and I have lost 80 pounds. (i was a slacker for the first few months)

doc billed tricare $33,000 and tricare paid $6,000. Tricare has also taken care of the adjustments (fills).

Total out of pocket for me was $50 for pysc eval, and $100 for protien shakes stuff the surgeon had me do preband. Money well spent!

Good luck!