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

Tricare prime



Recommended Posts

I am keeping it positive too! I feel pretty confident it will be approved. Looking forward to the pr-op diet......! I am, Tricare North too carolinagirl!

So ready to get this going! Have a great days! Lisa

Share this post


Link to post
Share on other sites

Tri-Care South. I had my "2d surgeon visit" 13 Jun. by then all pre-op requirements met, labs, ekg, 5-year diet history, 3-month supervised diet w/nutritionist, only thing left was psyc eval which I had forgotten about. Doc was ready to send our paperwork in for surgery approvals and July surgery dates. There were 5 of us at the "visit"--all at the same point. Having been through our supervised weight loss, all documents with the surgeon's coordinator.

The supervised weight loss serves a 2-fold mission. We really need to learn and evaluate how we are eating, what we are eating, why we are eating. If you get approval too quick; you don't have time to learn these very valuable lessons.

My doc (Cywes) is currently operating out of Tampa and West Coast. He's been doing these surgeries for years. In our conversation with him this past Thursday, (3 of the 5 of us were Tri-Care), he told us that Tri-Care does not approve "Sleeves". He does the band with a hybrid fold the length of the stomach (some will call it band with plication). Or he can do the band only. He defaults to the hybrid version of the surgery as a study he is providing data on. As of Thursday, he had done 450 of these surgeries.

He explained that the hybrid version gives the patient a much quicker weight loss up front like the sleeve does. The sleeve version of WLS, the stomach is cut away by half or so (lengthwise). If something were to happen later down the road and you needed that stomach--your out of luck. With the hybrid version, the stomach is inverted lengthwise and stapled; not only is there much less chance of chafing but also band slippage. The stomach is still a viable organ, still receiving blood, oxygen, the whole nine so to speak. If there are severe complications in your life at a later time, the procedure can be "un-done". This was a win-win for me. Based on my age (53), he would have opted for the sleeve--but that just hadn't been an option at any point for me. There's as he stated--no back out plan if your stomach goes bad.

Hope some of this helps.

Share this post


Link to post
Share on other sites

Tri-Care South. I had my "2d surgeon visit" 13 Jun. by then all pre-op requirements met, labs, ekg, 5-year diet history, 3-month supervised diet w/nutritionist, only thing left was psyc eval which I had forgotten about. Doc was ready to send our paperwork in for surgery approvals and July surgery dates. There were 5 of us at the "visit"--all at the same point. Having been through our supervised weight loss, all documents with the surgeon's coordinator.

The supervised weight loss serves a 2-fold mission. We really need to learn and evaluate how we are eating, what we are eating, why we are eating. If you get approval too quick; you don't have time to learn these very valuable lessons.

My doc (Cywes) is currently operating out of Tampa and West Coast. He's been doing these surgeries for years. In our conversation with him this past Thursday, (3 of the 5 of us were Tri-Care), he told us that Tri-Care does not approve "Sleeves". He does the band with a hybrid fold the length of the stomach (some will call it band with plication). Or he can do the band only. He defaults to the hybrid version of the surgery as a study he is providing data on. As of Thursday, he had done 450 of these surgeries.

He explained that the hybrid version gives the patient a much quicker weight loss up front like the sleeve does. The sleeve version of WLS, the stomach is cut away by half or so (lengthwise). If something were to happen later down the road and you needed that stomach--your out of luck. With the hybrid version, the stomach is inverted lengthwise and stapled; not only is there much less chance of chafing but also band slippage. The stomach is still a viable organ, still receiving blood, oxygen, the whole nine so to speak. If there are severe complications in your life at a later time, the procedure can be "un-done". This was a win-win for me. Based on my age (53), he would have opted for the sleeve--but that just hadn't been an option at any point for me. There's as he stated--no back out plan if your stomach goes bad.

Hope some of this helps.

Hey....thanks for sharing your story! I asked my surgeon and he was totally against that procedure. Not sure why, but I know he wasn't happy about it. Not sure why Tricare doesn't cover the sleeve either. Seems much easier than the full by-pass. The lateral plication with a band is basicially the sleeve with a band..! I guess I will just get the band and work it to best of it's ability!

Thanks again.... Lisa

Share this post


Link to post
Share on other sites

Not sure why Tricare doesn't cover the sleeve either. Seems much easier than the full by-pass. The lateral plication with a band is basicially the sleeve with a band..! I guess I will just get the band and work it to best of it's ability!

I had three women in the group with me that were approved by tricare for the sleeve. So, they do approve the surgery...maybe just not for everyone?

Share this post


Link to post
Share on other sites

The sleeve is still not an option for Tricare West patients either....I think it's an area thing. My surgeon said that because Tricare are a government insurance they will always follow Medicare and Medicaid guidelines and seeing as the sleeve has been approved by Medicare it's just a matter of time before Tricare approve it's use in all areas..

Share this post


Link to post
Share on other sites

Tri-Care South. I had my "2d surgeon visit" 13 Jun. by then all pre-op requirements met, labs, ekg, 5-year diet history, 3-month supervised diet w/nutritionist, only thing left was psyc eval which I had forgotten about. Doc was ready to send our paperwork in for surgery approvals and July surgery dates. There were 5 of us at the "visit"--all at the same point. Having been through our supervised weight loss, all documents with the surgeon's coordinator.

The supervised weight loss serves a 2-fold mission. We really need to learn and evaluate how we are eating, what we are eating, why we are eating. If you get approval too quick; you don't have time to learn these very valuable lessons.

My doc (Cywes) is currently operating out of Tampa and West Coast. He's been doing these surgeries for years. In our conversation with him this past Thursday, (3 of the 5 of us were Tri-Care), he told us that Tri-Care does not approve "Sleeves". He does the band with a hybrid fold the length of the stomach (some will call it band with plication). Or he can do the band only. He defaults to the hybrid version of the surgery as a study he is providing data on. As of Thursday, he had done 450 of these surgeries.

He explained that the hybrid version gives the patient a much quicker weight loss up front like the sleeve does. The sleeve version of WLS, the stomach is cut away by half or so (lengthwise). If something were to happen later down the road and you needed that stomach--your out of luck. With the hybrid version, the stomach is inverted lengthwise and stapled; not only is there much less chance of chafing but also band slippage. The stomach is still a viable organ, still receiving blood, oxygen, the whole nine so to speak. If there are severe complications in your life at a later time, the procedure can be "un-done". This was a win-win for me. Based on my age (53), he would have opted for the sleeve--but that just hadn't been an option at any point for me. There's as he stated--no back out plan if your stomach goes bad.

Hope some of this helps.

I am the Tampa area as well my surgery is being done at Saint Joseph's next week on the 25th! Good luck to you and keep us informed on your progress!

Share this post


Link to post
Share on other sites

I'm there with you! I did buy these awesome Protein drinks on Amazon that have two shots of expresso in them! vanilla Latte. I eat (drink) that for Breakfast. I also bought Protein Soups for lunch. Helps a LOT!

I lost 9 pounds in the three weeks leading up to my last appointment and have lost another 5 in 10 days! My liver better be the size of a pea when I'm done...lol! Ive lost

a total of 19 pounds since I started this process in January!

I sure hope this diet does not drop me below my required minimum because then they will postpone the surgery It is an evil catch 22 Damned if you don't Lose and Damned if you lose too much!!! I am borderline as it is! However the Protein powder they prescribed is not so bad its unjury, which kind are you taking?

Share this post


Link to post
Share on other sites

Tri-Care South. I had my "2d surgeon visit" 13 Jun. by then all pre-op requirements met' date=' labs, ekg, 5-year diet history, 3-month supervised diet w/nutritionist, only thing left was psyc eval which I had forgotten about. Doc was ready to send our paperwork in for surgery approvals and July surgery dates. There were 5 of us at the "visit"--all at the same point. Having been through our supervised weight loss, all documents with the surgeon's coordinator.

The supervised weight loss serves a 2-fold mission. We really need to learn and evaluate how we are eating, what we are eating, why we are eating. If you get approval too quick; you don't have time to learn these very valuable lessons.

My doc (Cywes) is currently operating out of Tampa and West Coast. He's been doing these surgeries for years. In our conversation with him this past Thursday, (3 of the 5 of us were Tri-Care), he told us that Tri-Care does not approve "Sleeves". He does the band with a hybrid fold the length of the stomach (some will call it band with plication). Or he can do the band only. He defaults to the hybrid version of the surgery as a study he is providing data on. As of Thursday, he had done 450 of these surgeries.

He explained that the hybrid version gives the patient a much quicker weight loss up front like the sleeve does. The sleeve version of WLS, the stomach is cut away by half or so (lengthwise). If something were to happen later down the road and you needed that stomach--your out of luck. With the hybrid version, the stomach is inverted lengthwise and stapled; not only is there much less chance of chafing but also band slippage. The stomach is still a viable organ, still receiving blood, oxygen, the whole nine so to speak. If there are severe complications in your life at a later time, the procedure can be "un-done". This was a win-win for me. Based on my age (53), he would have opted for the sleeve--but that just hadn't been an option at any point for me. There's as he stated--no back out plan if your stomach goes bad.

Hope some of this helps.[/quote']

Thank you for your post! It actually made so much more sense! I'm not sure if I'm getting the hybrid I would say not but its okay. I work with a girl that had gastric bypass in 2001 and just had LapBand done last year. She said her stomach grew and she was able to eat what she wanted. Although saying that ...in my opinion still eats like she doesn't have the band! I can now see why the stomach grew back!

Looking back through my weight loss journey (8 months) can say now that I'm happy that my surgeon made me loss weight and I had to do this two week pr-op because it has prepared me for my surgery! When we first started I was going to go with gastric. My BMI was 37 and my husband thought it was to severe. I've had colon cancer and at first my surgeon actually was the one pushing me for that but after he found out about my strong family history of cancer and colon in particular he said no to the bypass. Again without this waiting period I would have done the gastric.

Good luck with your surgery. As of yesterday TriCare has yet to approve me and my surgery is Thursday but my TriCare office on base told me there was some glitch with my file and every time the surgeons office sent in the supporting docs it canceled my request for approval. I'm suppose to get a call this morning. Ugh not sure if this delay in approval is TriCare or my surgeons office. In the mean time I'm sitting on pins and needles!

Oh and I'm there with you I'm 49 so I need to get this rodeo started!

Share this post


Link to post
Share on other sites

I got approval! My surgery is a go! Thursday June 20, 2013!

Congrats Cherie!!! Now the worry is over and time to celebrate!! are you ready? That is two days away so now you can relax the stress of the two week diet is almost over!!! I have my appointment with the anesthesiologist and nurse on your surgery day at 10 a.m. then the long weekend and then I will be following you Please Keep me posted!! Download the lapbandtalk app on your phone if you have not already!

Share this post


Link to post
Share on other sites

Congrats Cherie!!! Now the worry is over and time to celebrate!! are you ready? That is two days away so now you can relax the stress of the two week diet is almost over!!! I have my appointment with the anesthesiologist and nurse on your surgery day at 10 a.m. then the long weekend and then I will be following you Please Keep me posted!! Download the lapbandtalk app on your phone if you have not already!

Ill keep you posted! If I'm not able to use my phone tomorrow ...good luck on your surgery too!

Share this post


Link to post
Share on other sites

I got approval! My surgery is a go! Thursday June 20, 2013!

AWESOME......so exciting! That's tomorrow! PLEASE keep us posted!

Lisa

Share this post


Link to post
Share on other sites

I got approval! My surgery is a go! Thursday June 20, 2013!

Fantastic! What a relief that must be for you! Can't wait to watch your progress, Cherie!

Share this post


Link to post
Share on other sites

Cherie I'm just checking on you hope all is well!!! I go in to have mine done in the morning and I may be out of commission for a day or two but know I'm rooting for you!!!

Share this post


Link to post
Share on other sites

Cherie I'm just checking on you hope all is well!!! I go in to have mine done in the morning and I may be out of commission for a day or two but know I'm rooting for you!!!

Excited for you....good luck tomorrow...and keep us posted when you can! Lisa

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

    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
      · 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

    ×