Hey guys! Wondering if anyone is going through cTricare Prime for surgery. I just started my 2 month supervised weightloss program today. Got my refferal for a nutritionist on base and for my surgeon. Who I met on Nov 4th. Ahhhhh! I have a bmi of 40.1 and high cholesterol. Im so nervous about doing anything through Tricare.lol

I did. I had tricare standard tho

I don't live close enough to a base to have prime which was not cool because I had 20-25% copays

I have TriCare! I went to my pcp and told her I wanted surgery, she made me go to a nutrition class and said if I hadn't lost any weight in two months, come back in. That was in July. September I went back to her, hadn't lost any weight, so she referred me to the bariatric surgeon on base. He basically told me as long as I do everything I'm supposed to, and don't gain weight, I'll get the surgery. Sleeve or RNY - which I was surprised about because they TriCare online says the sleeve isn't covered, but it is through the base surgeon apparently. I'm still doing gastric bypass though. Anyway, got my labs, got my mental health, got my egd (well I'll be done with it Monday). So, my surgeon called me this morning and told me he has December 29th as my surgery date! All I have to do now is a bariatric nutrition class, then I'm getting my surgery. I have to be on a liquid diet for a week during Christmas (that sucks), but whatever! It'll be worth it when I'm healthy next Christmas!

Im retired Army and used my Tricare Prime for RNY during August. As your PCP has probably explained, Tricare requires two or more medical conditions to qualify for this procedure. I had to have three successive visits with my bariatric surgeon and nutritionalist (had to show weight loss progress over that three month period). Once the three visits were completed, it took less than a week for Tricare approval. Best decision I've ever made, down 70lbs in just over two months. Just make sure you pick a good surgeon that you are comfortable with. Good luck.

I have Tricare. My surgery was September 30th.

I had my surgery on the 30th to!

It's interesting that someone said u need two comorbitites. When I talked to tricare they said if you had a bmi of 40 you didn't have to have any comorbitites. I had 2 comorbitites (sleep apnea and acid reflux) and a 40 bmi. I also didn't have to do a 6 month weigh in with a pcp. In fact I only saw my pcp once and that was after I was approved (I needed a pre op physical done by her). I saw a nutritionist 4 month in a row because of my programs requirements and I was approved within a week. My program was more vigorous than tricare was. The only hard part about tricare was every time I called them I got different answers for the same question I had called about 2 days before. I was nervous about the approval but I had no problems. The only part that got frustrating was my insurance lady from my program called tricare to ask for an update on my claim and they told her it was approved. But they sent my approval letter in the mail ???? come on tricare. No one mails anything anymore. I couldn't get my date until the hospital had a hard copy of my approval letter.

I am retired and Tricare Prime. I am approved for my surgery on 23 Nov. I really did not have to go through any gyrations, not sure why. Maybe my moderate sleep apnea and my hypertension were enough, so there were no hassles. Like someone else said, Tricare (outside of the military treatment facility) will only pay for Roux-en Y, lap band, and one other I am forgetting. The sleeve is not an option with Tricare. My surgeon feels that Roux-en Y is best for me and I definitely did not need to look at trying to private pay for the sleeve. It has taken me a year to make up my mind (finally). I allowed friends to talk me out of it and went back to WW's and lost and regained and finally said I am only going to tell people who will support my decision. There are a lot of naysayers, who mean well, but cannot understand where I am and my struggles and failures. The prospect of doing something that is going to level my weight loss playing field is encouraging. I am nervous but determined to seize this opportunity to take charge of my health, my self-esteem, and my quality of life. I really appreciate reading what each of you are saying and about your experiences, it helps a lot!

I have Tricare Prime and received my approval letter in the mail today (it was submitted 5 days ago)! I was really worried about being denied. My BMI is right above 40 and no co-morbidites. Do you have to submit a personal letter to Tricare stating why you would benefit from the surgery? I did, as well as getting clearances from my primary doctor, nutritionist, psychiatrist, pulmonary, and cardiologist. I don't know if my surgeon will want me to do anything else prior to surgery.. I'll be calling first thing Monday to let his office know I was approved and hopefully have a surgery date soon.

Surgery set for Nov 16! These few weeks will fly by!

NewmaM83, no I did not have to write a personal letter. Not sure why you did and I did not? That is odd, it should be consistent across the nation. I am in Texas, Tricare (South) Humana. However, it is my understanding that unless your BMI is very high there must be comorbidities. Maybe you have a unique or special situation. I think that the insurance companies believe that the likelihood that the "morbidly obese" will develop comorbidities is so statistically significant that they think it is a smart investment. Congratulations on getting your date! Yes, it will fly by. Keep me in your prayers and I will do the same for you.

I agree, it is odd about the letter! A local friend of mine had the surgery early this year (also Tricare Prime but different doctor) and she didn't have to write a letter nor go through all of the clearances I did. I'm just glad that part is over and done with, and surgery is within sight....for you and me both!

I didn't have to write a letter but my doctor wrote me a letter of medical necessity when they submitted my package to tricare.

NewmaM83 I am new to this site and still trying to figure out how everything works. Thank you for adding me as a friend. I will try to do the same. I am certain that Tricare Prime received a letter of medical necessity from my surgeon also. I will see him on Friday. I expect it to be a long visit because, so they say, that is my last appointment to see him before the surgery....I guess unless I feel I need to see him. I found that a little unnerving. That is a long time. But I am certain that I will be busy with the pre-op diet and etc. I will post again after that appointment so that we can compare experiences. I also had to do a lot of specialty consultations (cardiology, pulmonary, and hematology, and additionally had a mandatory EGD). It has been interesting and comforting in a way. Nothing was uncovered that will prevent the surgery. That was the most important thing.

I had to switch to standard. I live near a MTF so was automatically sent there. They have a 12m waiting list, though, and seemed to really REALLY emphasize death. I didn't feel confident in them at all. I was told, though, the only way I could go out in town was to switch to standard so I did. Copays suck, but it's worth it in the end. I went to the surgeon's office for the first time in Sept. They were ready to give me a Nov date. I chose Dec because the hubs isn't stationed here. I didn't have to write a letter. According to their site, BMI over 44 or over 33 with 2 comorbidities. I am a 43

Hello,

I am new here as well. I made my decision and found my surgeon. I wanted the bypass, then the sleeve, and then was reminded Tricare doesn't cover the sleeve. He wants me to do the Band. I don't want to do the band I all. I've decided to go back to the bypass, but my surgeon has me terrified. I have yet to talk with him so see if he will even do the bypass. If not, I guess I have to start everything all over again. I just need to have clearance from psychology, get an EGD done and do 3 months of nutrition visits. I will have to change surgeons if he is really against bypass. I won't feel comfortable with an unhappy surgeon doing my surgery. I'm feeling overwhelmed at the moment because I thought I had it all figured out. Now i'm kind of a mess.

Why did some of you decide on the bypass over the sleeve and/or lapband? I'm just curious. I feel like going back to my original decisions has me all freaked out for some reason. When I made the original and absolute decision, I felt like a weight had been lifted.

First and foremost, based upon my own waffling in the beginning I can say you are not alone with it. My surgeon told me immediately that he would not recommend the lap band for me because it did not appear that I am a binge eater. I am not a binge eater. That was not something I expected to hear, but I was not especially interested in the band. I have heard many instances of problems that resulted in ending up with a completely new procedure, for various reasons. For me it was "Why the RNY versus the Sleeve?" He said," your insurance won't pay for the RNY (true) and if your concern is about the nutritional supplements that you will have to take for the rest of your life (RNY) there is little difference for people with the sleeve." I don't think it really worth your paying out of pocket, and I say that despite the fact that I will make more money if you pay out of pocket." So, I am going to have the RNY on 23 Nov with TRICARE PRIME paying for it.

Am I nervous and bit anxious? Yes Do I think it will be a cake walk? No But, I do have a supportive and confident surgeon. I think that if I were having the same conversations that you are having with him, I would find a new surgeon. I have to feel we are on the same team and that he believes that what he is doing is best for me too. It is hard enough dealing with naysayers in my social/family circle. I don't need that from my surgeon. Unless he tells you why one versus the other and convinces you that he is right....it is time to find someone you really trust and can talk freely with about this conflict. That is my two cents worth! Good luck and I really mean that.