So a little history since this is my first post... I have been overweight since I was 5 years old and I've tried almost EVERYTHING you can think of. It took us 7 years to conceive with our son and when he came out, he had complications and needs a feeding tube until he can eat on his own. I really think that me being overweight and having diabetes contributed to all the complications.....

Well...I finally sat down with my PCP and he insisted I get a lapband...I didn't know Tricare covered it and he instantly put in a consult....

fast forward to today......

I had my seminar and my one on one appt with the doctor. He evaluated me and told me that my diabetes is extremely out of control (A1C: 11.5) and he thinks that with the lapband i'd be better...He wanted me to get the gastric bypass but I insisted that all I needed was a boost or a tool to help me and I can do the rest of the work....

To my understanding TRICARE covered if you had a BMI of 40 with one or more comorbities. They measured me at 4'6 and 180lbs. So my BMI was exactly at 40. I have type II diabetes, hypertension, infertility and PCOS. So i was super excited with the surgeon told me that i am an excellent candidate for surgery.

WELLLLLLL....

As I was checking out...the lady told me that TRICARE/TRIWEST doesn't go by BMI but they go by weight. I have to be 100lbs over my ideal weight and with one comorbity. WTF?! First they tell me that my ideal weight for my height is 99, which when I checked through the Met-Life chart my ideal weight for a SMALL FRAME (which I think im a small frame if im 4'6) is 76-102. I dont know what tricare uses to determine someones ideal body weight..PLEASE HELP...

I came out of the building with the surgeon telling me he will still request it...if it gets denied to appeal it.........this saddens me.

Have you contacted your insurance company? Tricare has changed their policy since I had it done a year ago. Have your surgeon put in for it but contact your Tricare rep. Don't get discouraged. I was 100 lbs overweight with no comorbidities and was covered. Again, their policy has changed and I think it goes by BMI now but your rep will know.

Well, here on the east coast I have Tri-care. I'm retired Navy and use Tri-care standard. I can tell you that here on the east coast, it's as others said... 100 pounds over ideal weight, BMI of 40-45, OR.... less than 100 pounds/lower BMI but have co-morbidities such as HBP, diabetes, etc...

I can also tell you that insurance wise, the process here has been fairly simple. My problems have been with doctors communicating with other doctors, giving their blessing, etc...

I can also tell you that my doctors' office here is very happy with Tri-care and they told me it is highly unusual to get a denial from them. I did not get denied; approved first time through.

Hope that helps, and if you have any questions for me, let me know!

Stan

I am on the west coast and have Tricare. My process has been very fast and I am hoping to have an approval by next week. I was told by my doc and Tricare rep that you need to be a) 100 lbs overweight WITH a co-morbidity that they have listed on their website (I am 125 over and have hypertension...you have 2 that you listed but may be short on the weight); or 200% overweight. My doctor goes on the high end of what your ideal weight is because that is what most insurance companies do. I wish you luck!

I to have tricare west and was told that i had to be 100+ over with a bmi of over 40. I only starrted this process back at the end of oct of 2010 and have gone through every hoop that they wanted including the 6 months of being on a supervised diet and seeing a nutrisionist during that 6 month period, and have gone through the all the pre-op testing requirements, which they approved, but they won't approve the surgery. I know how you feel about being discouraged as I am to. I'm a little lost with what to do now. I'm going through a different office instead of through balboa here in san diego. but they haven't called me or anything. I'm a little bummed and irritated at the same time. Am thinking of going back to talk to my PCP, but they always try to sucker me into doing other checkups that I don't want to have done. I just want this process to be done and over with because it is stressing me out so much these days.