UHC Military West/Tri-care West coverage

[cosmicbubbles 5]

I am a child (19 years old) still covered by my active duty father's insurance (UHC Military West/Tri-care West) and I am covered to do the RNY surgery, but I absolutely have my heart set on the sleeve. I keep running into rumors and old posts about possible coverage, the latest of which is that it will be covered by January 10 of 2014, but I can't find anything supporting that rumor. Is there a way I can get it with my civilian doctor? (I also have my heart set on him, I will not go to another center to have it done). Is there a way I can get them to cover my specific case if there isn't a possibility for it to be approved anytime soon?

[shaza1963 71]

Contact your tricare office and they will be able to answer your questions correctly. I am using tori care as we'll and I am getting sleeved on February 6 and since I am voles to a military facility I have to have it there, which is ok because he comes highly recommended and he's nice. Good luck.

[BlueLotus77 6]

I also have Tricare West, but we have a big giant miliary hospital here at JB Elmendorf/Richardson. The bariatric surgeon here actually mostly performs the gastric sleeve. But he is a military surgeon, so there is no jumping through hoops with insurance. I know where your confusion comes in though, because Tricare actually says it doesn't cover the vertical sleeve gastrectomy. So...i dunno! The best thing to do would be to go and talk to your PCM and see what they say. They'll refer you to a surgeon and you'll go from there! Good luck!!

[wendybringhurstakrealtor 10]

I just sent you a private message bluelotus77

<p>I also have Tricare West, but we have a big giant miliary hospital here at JB Elmendorf/Richardson. The bariatric surgeon here actually mostly performs the gastric sleeve. But he is a military surgeon, so there is no jumping through hoops with insurance. I know where your confusion comes in though, because Tricare actually says it doesn't cover the vertical sleeve gastrectomy. So...i dunno! The best thing to do would be to go and talk to your PCM and see what they say. They'll refer you to a surgeon and you'll go from there! Good luck!! </p>

[LouiseandThelma 8]

Hi,

I have a similar situation myself. I was approved back in Dec for Roux en y gastric or the band. I also have my heart set on having the sleeve. My doctors office called me two weeks ago to let me know that I couldn't have the sleeve, because I have USFamily Health Plan and they won't approve the sleeve. Not just because my insurance will not cover the surgery, but because of the communication with the medical office coordinator and the financial coordinator. I am going to check into changing over to Tricare Stardard, so I can have the sleeve at a MTF. I am not sure how all of this will play out, but I have come too far not to finish.

But as far as your question about the sleeve being covered by 1/10/2014, I have not heard anything and the only place I know it is covered for family members is through MTF. But I could be wrong. I am interested in any information on the process I need to take .

[cosmicbubbles 5]

Update on this: I went to my civilian surgeon for our necessary diet meetup, and he said that because the federal government has approved it, I can most likely be approved to have that surgery done by him. No absolute confirmation yet, but there seems to be some hope!

[LouiseandThelma 8]

Good Luck and I hope it all works out. Keep us posted on your journey.

[cosmicbubbles 5]

Well, the depressing truth is that we all tried our hardest but it's just not something that is going to happen. I am determined to get the sleeve, and would like to know if anybody can recommend an MTF in southern california who will perform it?

[LouiseandThelma 8]

I talked to someone at the bariatric clinic today at WalterReed (MTF) and to be considered for their program you have to be enrolled in Tricare prime and use the base clinic and get a referral from your PC. I talked to the tricare office and you can't use tricare standard to go to the MTF. I don't understand why, but that's what they told me. I will be changing over to Prime sometime in February and start working on my referral.

[sweetpea71 1]

I previously had the lap band procedure done back in 2010 but suffered with abdominal issues the whole time with it. When my doctor in CO took it out he said that I could have the sleeve done but we were getting ready to PCS so I had no time to do it. I did so good while having the band on because I was using it as a tool like you are supposed to but once it came off and we moved and then I blew my knee out and the depression set in again because I couldn't work out, I have put the weight back on and now we are again getting ready to PCS. Does anyone know who does the gastric sleeve in the Massachusetts area and whether it is covered by tri care? My last one was done at a military hospital so it wasn't a problem. Any help with this would be appreciated!!

Kathy

[LouiseandThelma 8]

Kathy,

You are going to have to research the area in Mass. If there is a miltitary treatment facility then you are in luck. But from what Tricare told me they will cover everything except the sleeve. The sleeve is only covered under the MTF, which doesn't make any sense. Are you close to a facility now and how long before you move again? I hope this helps. Don't give up!

Jana

[jjack929 0]

I have US Family Health Plan which I guess fals under Tricare Prime. I have to be seen at Johns Hopkins facilities. I was scheduled for a sleeve today at Sibley Hospital in DC, have been at this for almost a year, and learned last week that Tricare will not cover the sleeve because it's too new, but they will cover the bypass. I really, really don't want a bypass.

I talked to someone at the bariatric clinic today at WalterReed (MTF) and to be considered for their program you have to be enrolled in Tricare prime and use the base clinic and get a referral from your PC. I talked to the tricare office and you can't use tricare standard to go to the MTF. I don't understand why, but that's what they told me. I will be changing over to Prime sometime in February and start working on my referral.

[LouiseandThelma 8]

I have US Family Health Plan which I guess fals under Tricare Prime. I have to be seen at Johns Hopkins facilities. I was scheduled for a sleeve today at Sibley Hospital in DC, have been at this for almost a year, and learned last week that Tricare will not cover the sleeve because it's too new, but they will cover the bypass. I really, really don't want a bypass.

I talked to someone at the bariatric clinic today at WalterReed (MTF) and to be considered for their program you have to be enrolled in Tricare prime and use the base clinic and get a referral from your PC. I talked to the tricare office and you can't use tricare standard to go to the MTF. I don't understand why, but that's what they told me. I will be changing over to Prime sometime in February and start working on my referral.

JJack929,

Yes, USFamily is Tricare. I even called USFamily for WLS benefits and they were very vague on the sleeve. I also wasted a year with JH. I'm now having to wait until late summer or early Fall to have my surgery. We are transferring in 4 months and I don't want the stress of starting the process all over right before a move.

Since you were approved for WLS you have up to 2 yrs to have surgery. As long as you still meet their requirements. Are you close to a military clinic? Would it be an option for you to change over to a new PC and try to start the process with Walter Reed? They do the sleeve over there. You already have all the requirements done. If I was staying here another year I would change out of JH over to Tricare (Prime). Its worth the call to the Bariatric Clinic at WR. leave a message and they will return your call within 2 days. They will try and answer any questions you may have. The one thing they will tell you that you have to come out of USFamily.

I wonder if you worked with the same financial person at JH as I did. I have requested all of my WL records (2 weeks ago), and I'm still waiting.

I wish you luck! Hang in there, its not the end of the road you are just taking a Detour for now. Message me if you have any questions.

Stormrunnin

[sweetpea71 1]

I'm not sure which clinics do bariatric surgery and I put a call into one and never heard back. I guess I will just have to wait until we move.....

[cosmicbubbles 5]

Update on me: I found that San Diego (The Naval Medical Hospital/Balboa hospital) will do the VSG and I am close to being in phase two when I can schedule my surgery. I'm so excited! They're even accommodating for me having a long drive to make and are allowing me to fax in a lot of my test results.