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



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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.

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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

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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:

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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 ....

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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.

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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.

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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.

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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.

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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.

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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

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