Looking for Tricare Prime Users

[Bring It On 55]

Hello my new friends -

Starting my journey to healthy living. I have Tricare Prime insurance (my husband is retired military). I called Tricare, and was told that they did not cover the sleeve surgery and would not say that they would not cover Plication. What I would like to know is, has anyone who has Tricare used their insurance for the sleeve. I just don't understand why they would rather me do a gastric bypass when it is more expensive!! Of course, I don't understand the insurance business anyway. I have 2 co-morbidities with 90 lbs to lose. Any help would be appreciated!!

[Schoe394 7]

I have Tricare prime although active and in the process of getting the sleeve surgery and I have known a lot of people get it done through Tricare and had no problems with them.

[Bring It On 55]

Thanks for your response. When you pull up what is covered on their website, it says it does not cover the sleeve. I feel like whenever my claim gets submitted with the co-morbidities, I can always ask for a review if they give me any trouble. I am determined to have this surgery one way or another, I would just rather it come out of their pocket instead of mine!!

[Pugmadkate 61]

Tricare Prime does not cover the sleeve by civilian providers. I've been through the process. It is not covered.

I am the spouse of a retired Marine and had my sleeve done at Brook Army Medical Center. Unless you can get to a military medical facility that does sleeves, you will have to pay for it out of pocket.

[Pugmadkate 61]

I wanted to add that I had several doctors offices incorrectly tell me that Tricare Prime would cover

the sleeve but when I checked with Tricare, they were very clear that they do not cover it.

I'm sorry. I know that's not what you want to hear and it is very frustrating. I was very lucky to be within driving distance (3 hours) of a military medical center that did the sleeve.

[Bring It On 55]

Hate to hear that about Tricare. I looked on the VA website for Lexington, KY. All they show is something about MOVE. Is that the program you have to go through before they will do the sleeve surgery? If so, how long does it take? What hoops did you have to jump through to get your surgery? Thanks!

[BitterSweet* 835]

Pugmadkate is correct. The sleeve is only covered if it's done at a military installation that does them. MOVE is their pathway program to WLS, though the name varies from facility to facility.

1). Referral from PCP to the program.

2). Enrollment in the next "class" which can vary. They limit the class sizes to about 20 people. I waited about 6 wks after being enrolled before my class opened. The first orientation class lasted about 3 hrs. You are introduced to the whole team of people: Surgeon, Nutritionist, Bariatric RN etc. Then you'll get a person-to-person visit with the surgeon that same day.

3). You are required to attend one support group meeting. They are only held once per month.

4. Two meetings / classes are required with the MOVE Program. They are about 6-8 weeks apart.

5). After the two MOVE classes, you'll have a one-on-one appointment with the dietician / nutritionist. You will be required to bring in your food journal and fitness journal to every appt you go to. You will be weighed at every appt.

..........The requirement is simply that you do not gain weight. You must either maintain your starting weight or lose weight - again, the latter not being required. You will have to do a 2 week liquid diet before surgery in order to shrink your liver so that the procedure can go smoothly.

6). If you have been compliant, the dietician usually clears you for surgery after one visit. If not, you'll have to continue individual nutrition classes until you demonstrate the ability to comply with a new way of eating and journaling.

7). Once cleared by Nutrition, your Psych Eval will be scheduled. Only one appt is required unless you are not cleared due to any "red flags"; if so, you'll have to return for another appt.

8). Once cleared by the Psychiatrist, your EGD gets scheduled and lab work repeated. If you have known medical problems that you see a specialist for, you'll need medical clearance from them around this time.

9). If your EGD is fine you are scheduled for a final appt with the surgeon to answer any last questions, then you are scheduled for surgery. If you are positive for H. Pylori, you will have to be treated with antibiotics until it is cleared; usually 2-3 weeks and they'll do a blood test to confirm that its presence is no longer in your belly before they will perform your surgery.

10). If your surgeon is NOT scheduled to deploy overseas or go TDY, and if you make every single appt and are compliant, surgery can happen about 4 months after beginning the process.

Hope this helps!

[#9grammy 274]

I have Tricare standard as a secondary ins. I was told they will not cover me unless I was 100 pounds or more overweight. So I will be picking up what Medicare doesn't pay.

[Bring It On 55]

Thanks for all the feedback. I have found out that Tricare will definitely not cover the sleeve or plication. My only other option is Gastric Bypass. I really hate to have a surgery I really hadn't planned on, but if I don't I will be out 15-20K. Bummer!!