Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Tricare Not Requiring A 6 Month Weight Monitoring Prior To Lap Band Surgery?



Recommended Posts

So far I've talked to my PCP, got a referral, called my insurance to see what they required, and am going to a seminar tomorrow. I am scheduled to meet with my surgeon on Sept 6th. However, when I called the surgeons office the insurance woman there was in disbelief that tricare doesn't require a 6 month weight monitoring. Now granted I'm sure they dont get a lot of tricare patients because I live nowhere near a base. but anyhow.

When I spoke with Tricare on the phone (and looked it up on their website) I was told that I have to be 100 lbs over weight (check) with one or more comorbidites (I've got THREE) and have a phsyc eval...

Anyone with Tricare have to have the 6 month weight monitoring? I've got medical history showing obesity for the past 10 years, but never six months back to back.

Share this post


Link to post
Share on other sites

As far as I know, and have ever heard, Tricare does not require a six month weight management. In fact, their website states they won't even pay for nutritional counseling. They certainly didn't require it when I had my surgery last year. They're considered one of the easiest insurance carriers to get a surgery approval from.

I suggest you go back to the Tricare website and print out the requirements, so you can show the insurance coordinator at your surgeon's office. The more proactive you are, the smoother your process will be.

Good luck!

Dave

Share this post


Link to post
Share on other sites

I have Tricare and didn't have to wait 6 months. I have also had 2 visits with the Nutritionist and the Shrink, but that may be all in the Dr's coding. It was pretty easy... I agree with Dave. :rolleyes:

Share this post


Link to post
Share on other sites

im going thru it now and i am also worried about the 6 month thing they just changed there policy i guess to needing 6 months before you can have surgury ....

Share this post


Link to post
Share on other sites

I just had surgery on Nov. 3, 2011 and did not have to do a 6 month diet. I have Tricare (north) Prime. My surgeon also stated that Tricare was pretty easy to get an approval from. For the most part if your PCM/PCP will give you a referral and it's approved surgery is approved unless something else pops up with all your pre-op testing.

Share this post


Link to post
Share on other sites

Hello, we are at Camp Lejeune NC. I have tricare prime. I have to do the 6 month diet nutrition plan. I started in Nov 2011. I go to my PCM every month have her sign the paperwork. My surgeon said try to stay the same weight as I am border line for the BMI weight limit for insurance to pay for the surgery.

Share this post


Link to post
Share on other sites

I am also tricare and got my surgery just as they started having the proven diet/ medically supervised weight loss qualification. They did NOT used to require this, but the new policy that came into effect last year in the early fall now does state that you have to be able to show that you have been on a medically supervised weight loss program and be unsucccessful with the weight loss. That being said... I was told that they want at least 3 months, that you have to document going in every month, and you have to have documented in your medical record what you are doing about it. I saw my pcm to start the process and immediately went to the nutritionis on base. She gave me a calorie plan to follow and I followed up with my pcm every month for 4 months to get approved. While I did lose some weight, it was not considered enough to have been clinically significant so I was approved and had my surgery Oct 13 , 2011.

Share this post


Link to post
Share on other sites

I just had band surgery Feb 3rd and did not have to do a six month diet. I am in Tricare South. From what I have heard depending on which Tricare region you are in depends on if they require the diet or not. I had to pay out of pocket 50.00 for a nutrition class at the surgeons office.

Share this post


Link to post
Share on other sites

I did this back in 09 and didn't have to do the 6 months, but............The first dr. I was considering told me it was required by TriCare (I am in VA with Standard), and that it had to be the program that the office offered. I think it was Medifast (?) to the tune of about 800 bucks!!! Which I was told would be out of pocket as well as another 300 for the trainer. I researched and learned that it was NOT TriCare, but the doctor. The only reason I even questioned it was because I didn't understand that if TriCare approved the surgery why wouldn't they cover the "required" elements. It was ugly, doc's office had to own up to the fact that it was them. I went south and found great care and no BS! I don't think it has changed, so do as Dave said and push if need be. Good Luck.

Share this post


Link to post
Share on other sites

regnu DO U,HAVE TRICARE PRIME? IM IN SOCAL I HAVE LOTS OF QUESTIONS IM STATIONED AT FORT IRWIN EMAIL ME PLEASE STEPHANIEMACIAS1@GMAIL.COM

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

    • NovelTee

      I'm not at all hungry on this liquid pre-op diet, but I miss the sensation of chewing. It's been about two weeks––surgery is in two days––and I can't imagine how I'll feel a couple of weeks post-op. Tonight, I randomly stumbled upon a mukbang channel on YouTube, and it was strangely soothing... is it just me, or is this a thing? 
      · 1 reply
      1. NickelChip

        I actually watched cooking shows during my pre-op, like Great British Baking Show. It was a little bizarre, but didn't make me hungry. I think it was also soothing in a way.

    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 3 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

      3. NickelChip

        I think it's important to remember that the weight charts and BMI ranges were developed a very long time ago and only intended to be applied to people who have never been overweight or obese. Those numbers aren't for us. When you are larger, especially for a long time, your body develops extra bone to support the weight. Your organs get a little bigger to handle the extra mass. Your entire infrastructure increases so you can support and function with the extra weight. That doesn't all go away just because you burn off the excess fat. If you still had a pair of jeans from your skinniest point in life and then lost weight to get to the exact number on the scale you were when those jeans fit you, chances are they would be a little baggy now because you would actually be thinner than you were, even though the scale and the BMI chart disagree. When in doubt, listen to the jeans, not the scale!

    • Aunty Mamo

      Tomorrow marks two weeks since surgery day and while I'm feeling remarkably well and going about just about every normal activity, I did wind up with a surface abscess on on of my incision sights and was put on an antibiotic that made me so impacted that it took me more than two hours to eliminate yesterday and scared the hell out of me. Now there's Miralax in all my beverages that aren't Smooth Move tea. I cannot experience that again. I shouldn't have to take Ativan to go to the lady's. I really looking forward to my body getting with the program again. 
      I'm in day three of the "puree" stage of eating and despite the strange textures, all of the savory flavors seem decadent. 
      I timed this surgery so that I'd be recovering during my spring break. That was a good plan. Today is a state holiday and the final day of break. I feel really strong to return to school tomorrow. 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
      For second breakfast on workdays, I will have a low-fat yogurt with two tablespoons of PBFit and two teaspoons of no sugar added dried cherries. I will have ingested 35-45 grams of protein at this point between the two breakfasts, with 250-285 calories, and about 20 carbs.
      For second breakfast on non-workdays, I will prepare two servings of plain, instant oatmeal with a tablespoon of an olive oil-based spread. This means I will have had 34 grams of protein, 365 calories, and 38 carbs. Non-workdays are when I am being very active with training sessions, so I allow myself more carbohydrate fuel.
      Snacks on any day are always mixed nuts, even when I am travelling. I will have 0.2 cups of a blend that I make myself. It consists of dry roasted peanuts, cashews, pumpkin seeds, sunflower seeds, pistachios, and Brazil nuts. This is 5 grams of protein, 163 calories, and 7 carbs.
      Breakfast and snacks have been the easiest to nail down. Lunch and dinner have more variables, and I prepare enough for leftovers. I concentrate on protein first, and then add vegetables. Typically tempeh, tofu, or Field Roast products with roasted or sautéed vegetables. Today, I will be eating leftovers from last night. Two ounces of tempeh with four ounces of roasted vegetables that consist of red and yellow sweet peppers, sweet potatoes, small purple potatoes, zucchini, and carrots. I will add a tablespoon of olive oil-based spread, break up 3 walnuts to sprinkle of top, and garnish with two tablespoons of grated Parmesan cheese. This particular meal will be 19 grams of protein, 377 calories, and 28 grams of carbs. Bear in mind that I do eat more carbs when I am not working, and I focus on ingesting healthy carbs instead of breads/crackers/chips/crisps.
      It's a helluva journey and I'm thankful to be on it!
       
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×