tricare prime north region

[formykids2 4]

I have searched many boards, and many sites and still do not have a good straight answer to my question.... Does tricare north require a 6 month supervised diet? I have seen some here say yes, some drs offices say yes, some say no and I did call tricare and 2 different people said they had no idea what i was talking about and that there was NOTHING in their information about that being a requirement or even a request, and i have a neighbor who had the band without the 6 month. So ultimately, my question is has anyone with tricare prime in the north region had this without having the 6 month requirement??

[Mimilou2004 13]

North South East or West, the requirements are the same for TRICARE and there is NO 6 month diet mandate.

Mimi

[Dave_NW 92]

The reason nobody at Tricare knew what you were talking about is because Tricare Prime does not require it. But a local surgeon MAY require it. And that's where the confusion sets in. Find a surgeon who does not require it, and you'll be good to go.

Dave

[formykids2 4]

i know everyone says there isnt supposed to be one, but my question is, is there anyone in north region that had the surgery without the 6 months. I want to know that I have a leg to stand on when I go in and say that they do not have that listed as a requirement. If I have to do it obviously I will, but I would rather get this done sooner rather than later of course.

[Short and Chunky 230]

I have searched many boards, and many sites and still do not have a good straight answer to my question.... Does tricare north require a 6 month supervised diet? I have seen some here say yes, some drs offices say yes, some say no and I did call tricare and 2 different people said they had no idea what i was talking about and that there was NOTHING in their information about that being a requirement or even a request, and i have a neighbor who had the band without the 6 month. So ultimately, my question is has anyone with tricare prime in the north region had this without having the 6 month requirement??

[Short and Chunky 230]

I too have Tricare and they did not require the 6 month pre-op diet. My doctor did not require it either. I did have a two week diet and today is my 2nd day of the liquid diet as my surgery is tomorrow. Be thankful you have Tricare !

[formykids2 4]

I appreciate the replies that I have gotten so far, but I know that no other region expects this. My concern is stricktly related to the North Region. I have found that they all pay for it, but that they (the North region) may have different criteria in order to get it approved. I will be meeting with my surgeon in a couple of weeks so I guess we will find out when we actually submit papers for auth.

[Dave_NW 92]

I appreciate the replies that I have gotten so far, but I know that no other region expects this. My concern is stricktly related to the North Region. I have found that they all pay for it, but that they (the North region) may have different criteria in order to get it approved. I will be meeting with my surgeon in a couple of weeks so I guess we will find out when we actually submit papers for auth.

I can appreciate the confusion and frustration. The deal with Tricare Prime is they have very specific rules about what they will and won't pay for. They do not require a 6 month diet, period. All they require is that you fit the eligibility requirements listed on the Tricare website, regardless of the region you live in. But the surgeon you go to MAY require a managed weight loss program, and may insist you go through that before they will agree to give you a lap band. That was why I said you should find a surgeon who doesn't require it.

When you meet with your surgeon again, if they say you need a supervised diet, ask them why, since your insurance carrier doesn't ask for that, and won't pay for nutritional counseling. It could be that your surgeon may want everyone to go through that process, since some insurance carriers DO require it. The surgeon may just want all their patients to go through it, as a matter of course. And it may also be the surgeon's insurance coordinator may not know Tricare Prime doesn't require a supervised diet, and may be askig for something that isn't required. So this could be your chance to educate them.

If you spend time on the Tricare website, and print out the specific pages that apply, you can show your surgeon why you don't want to have to go through a 6 month prescribed diet.

Good luck!

Dave

[formykids2 4]

sounds like a plan. if they give me any guff i'll just say show me the instruction (er, uh i mean, show me in writing :-) ) I dont do well at all with this wishy washy stuff and just want a clear cut/ black and white list. I know based on the current weight guidelines that I just by the hair of my chin qualify, and with the new rules coming soon I well fall into that too. I look forward to the appt with them to get it all submitted. By the way, does Tricare want all of the labs and such done before approval or just have it done before surgery?

[Dave_NW 92]

sounds like a plan. if they give me any guff i'll just say show me the instruction (er, uh i mean, show me in writing :-) ) I dont do well at all with this wishy washy stuff and just want a clear cut/ black and white list. I know based on the current weight guidelines that I just by the hair of my chin qualify, and with the new rules coming soon I well fall into that too. I look forward to the appt with them to get it all submitted. By the way, does Tricare want all of the labs and such done before approval or just have it done before surgery?

I don't know if Tricare requires labs to be done before approving you for surgery. I think that's more likely a surgeon's thing. Depending on your weight history, the surgeon may require things like a sleep study or an endoscopy to be done before he/she will submit a request for surgery to Tricare. But as for Tricare themselves, I think they only want your surgeon to ask for approval because they feel you are a good candidate for surgery.

To help you out, here is the calendar of events I went through:

Referral from PCM to WL Surgeon 19-Aug-10

Attended Mandatory WL Seminar 25-Aug-10

1st Consult - Dr. McMahon/Staff 29-Sep-10

Lab Work Completed 1-Oct-10

Endoscopy 14-Oct-10

Surgery Request Submitted to Insurance 15-Oct-10

Surgery Approval Received from Insurance 20-Oct-10

Consult - Dr. Kaufman (Ventral Hernia Repair) 16-Nov-10

2nd Consult/Sign Surgery Papers - Dr. McMahon/Staff 16-Nov-10

Surgery Day 6-Dec-10

101 Pounds Lost 6-Jul-11

Hope this helps,

Dave

[LVGirl 4]

The testing is all required by your surgeon...but I had to have all of mine done before it was submitted to Tricare.