Tricare Prime North

[☠carolinagirl☠ 18,722]

here is what I got off the Tricare page today:

Bariatric Surgery

TRICARE will cost share any of the following open or laparoscopic bariatric surgical procedures:

• Roux-en-Y gastric bypass
  
• Vertical banded gastroplasty
  
• Gastroplasty (stomach stapling)
  
• Adjustable gastric banding (i.e., adjustable LAP-BAND®)
  

If you meet all of the following conditions:

• You're at least 18 years old or you provide documentation of completion of bone growth.
  
• You were unsuccessful with non-surgical medical treatments for obesity. Your medical records must show your failed attempts.
  
  • Diet programs, such as Weight Watchers®* and Jenny Craig*, are acceptable methods of dietary management, as long as there's medical documentation of participation and monthly clinical visits with your doctor. *These programs aren't covered by TRICARE.
    
  • Physician-supervised programs made-up of only weight-loss medication management, don't meet this requirement.
    

  [*]You have proof of one of the following:

  • A body-mass index greater than or equal to 40 kilograms per meter squared (kg/m2); or
    
  • A body-mass index of 35-39.9 kg/m2 with one clinically significant comorbidity, including but not limited to, cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, Pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy, or pulmonary hypertension.
    

Last Modified:October 31, 2011

I meet all these items.........but I do not have have high blood pressure or diabetes. Will I be denied lap band surgery??

[hedder14 59]

If you BMI is greater then 40 you should be ok. If less then 40 do you have any of those problems listed other then the high blood pressure and diabetes?? if so then again you should be fine..

[☠carolinagirl☠ 18,722]

no, its greater than 40 and 50. It teeters on 59/60 (depending on the height chart). I have not done Jenny Craig, but briefly did WW and have been w/TOPS since 88 (same as WW but cheaper)..

[hedder14 59]

You should be good to go.. You dr. knows how to write out the auth for you...

[☠carolinagirl☠ 18,722]

I hope you are right (bc via my blog entry) she sure made me feel (not so sure) of approval...

[armymom2012 51]

I have Tricare Prime North and I was below the 40BMI, but because I have High Blood Pressure, cholesterol and joint issues related to my weight, they passed me right through. I did have to do a psych evaluation and an EKG, prior to being approved, but other than that, I did not have to show proof of 6 months trying to lose weight, but my doctor did state in her letter that she had been my doctor and had been seeing me for over 5 years and that I had been over weight all that time, which had been causing issues with my health. The only thing I had put on my application as attemts to lose weight over the years was, weight watchers, the gym, pills etc. But they didn't need to see written proof. Hope everything goes your way. I don't regret my choice at all. Plus the weight is coming off quicker than I thought:)

[☠carolinagirl☠ 18,722]

thanks army mom.....your response reads like my life minus the HBP/Cholesterol.....but I def have the joint pain etc............and my BMI is very high...(sorry to admit that but it is who I am)...I have completed all requirements they (clinic/dr) gave me....

If they deny me, I wont know what to do..

[MendyB 8]

I'm new to the site and thankful I found you!!!! I have Tricare North and I'm at 38 BMI with high blood pressure and depression. I just recently finished all my pre testing.. ie, psych eval, blood work, primary care doctors history and physical, surgical consult, seminar, documentation of physician supervise weight loss since 2005, upper GI and chest X-ray. The surgeons office notified me today my paperwork is being sent off. I'm scared to death they are going to deny me:-/ I know they would have never let me get this far if I didn't have some qualification but after reading different post I just got nervous they will not approve.

Does anyone know how long it takes? Some have stated Tricare is really fast but having past dealings with them it varies! Does it sound like I will qualify??? Oh my I think I'm reading and over thinking this too much

[hedder14 59]

I believe it took Tri care 8 day's to ok me... Don't worry about it, it sounds like you fit there guidelines.. If they do deny ( which i doubt by what you discribe ) you can always fight it.. Tricare requires a lot of tests before they will even look at your app, so try not get too nervous.. They do come back with an answer pretty quick...

Good Luck!!!

[COCAMOKIS 4]

Hi I have tricare prime South which honestly they are all the same when it comes to weight loss surgery. All I did was go to my primary care she referred me to the seminar because my bmi was 54 and I am only 4ft 11in, I went to the seminar and started completing everything that the surgeon required, I had to pay the program fee of $275.00 and my phyciatric evaluation which was $350.00 and that was it tricare covered everything else, I had no other illnesses just a bmi of 54 I told my primary care all the programs I had tried to loose weight she wrote them down and that was it. I was approved for surgery and I just got my band on the 3rd of April. I am not

100% sure that is how it will work for you but I don't see why not you have more alements then I did so your more of a candidate than I was. Good luck I hope this helped. My husband is stationed at Fort Stewart here in Georgia if that helps.