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

Recommended Posts

Tricare will only do a gastric bypass, Tricare will not authorize a sleeve. I called numerous times and they stated it was policy. They did authorize me for a gastric bypass but I couldn't do it. I went and had the sleeve done.

Share this post


Link to post
Share on other sites

Tricare will only do a gastric bypass, Tricare will not authorize a sleeve. I called numerous times and they stated it was policy. They did authorize me for a gastric bypass but I couldn't do it. I went and had the sleeve done.

Ya know I had that feeling! My doctors office told me on day 1 it was covered now by them as of just a few months ago but something is just not sitting right with me. I had a feeling it wasn't. I don't want the bypass. Now I'm really bummed ???? So did you pay for your sleeve out of pocket? I may end up just doing just that myself. Thanks for your information

Share this post


Link to post
Share on other sites

This is a bummer as we want to get my son the gastric sleeve.

It sure is hillbillienurse :( Ive had a message into my doctors office to do some investigating since last week and once I see what they say again I'll let you all know also. I'm just super upset cause as I said before I asked about this at my very first visit and I stated I didn't think it was a covered item and they said oh no as of 3 weeks ago it is now covered. And that was in November. I'm checking again.

Share this post


Link to post
Share on other sites

I am getting the sleeve through Tricare. It is covered. I am going to a civilian doctor. When I called the patient rep said "oh you have Tricare - just so you know the doctor was just at a conference and they announced that they will now cover the sleeve so if you want it we will submit for it." They submitted for it and I got approved in 3 days! It's covered. I feel so bad for everyone stuck on the misinformation that the Tricare line is giving. It's covered! And not just at the MTF! I'm going a civilian Doctor who is in the Tricare network as a network provider.

Share this post


Link to post
Share on other sites

I am getting the sleeve through Tricare. It is covered. I am going to a civilian doctor. When I called the patient rep said "oh you have Tricare - just so you know the doctor was just at a conference and they announced that they will now cover the sleeve so if you want it we will submit for it." They submitted for it and I got approved in 3 days! It's covered. I feel so bad for everyone stuck on the misinformation that the Tricare line is giving. It's covered! And not just at the MTF! I'm going a civilian Doctor who is in the Tricare network as a network provider.

No way!!!! Are you totally serious?!? I am so excited right now and such a feeling of relief! So they were right! Oh I want to kiss you! Lol. Do you know what their requirements are for it? What all do you have to do for them to cover it? Wahooooo!!!!????????????????????

Share this post


Link to post
Share on other sites

My surgery date is 2/1. All they require is the psych eval, surgeons consult note and dietician's consult note. You won't get cleared by surgeon unless you have met the BMI requirements and have done all the tests (GI, labs, chest X-ray). You won't get cleared by the dietician unless you have proof that you have tried a non-surgical physician supervised attempt at weight loss in the past (I provided documentation of a liquid diet I did through Kaiser - Optifast - in Jan 2013). Once you have all that, the doctors office needs to submit for the sleeve (as well as anything else you are considering). It will be approved. Do I need to take a picture of my auth letter????

Share this post


Link to post
Share on other sites

I am getting the sleeve through Tricare. It is covered. I am going to a civilian doctor. When I called the patient rep said "oh you have Tricare - just so you know the doctor was just at a conference and they announced that they will now cover the sleeve so if you want it we will submit for it." They submitted for it and I got approved in 3 days! It's covered. I feel so bad for everyone stuck on the misinformation that the Tricare line is giving. It's covered! And not just at the MTF! I'm going a civilian Doctor who is in the Tricare network as a network provider.

No way!!!! Are you totally serious?!? I am so excited right now and such a feeling of relief! So they were right! Oh I want to kiss you! Lol. Do you know what their requirements are for it? What all do you have to do for them to cover it? Wahooooo!!!!????????????????????

Lol!!!! I am soooooo serious!!! You have to have something showing you tried weight loss before. They say Weight watchers is ok as long as you were going to the doctor and being weighed but if you have regular doctors appointments where you discussed weight and regular weigh ins, they'll take it! Plus all the stuff i said above! :)

Share this post


Link to post
Share on other sites

It's so annoying because when I asked why the reps still say it's not covered, they said it's because they have to go off of what's on the Tricare.mil site. Until that site is updated, they will keep saying it's not covered!

Your doctor just has to submit for it. It will come back approved if everything else is fine. If it is denied it will be for something other than "it's not a covered service".

Share this post


Link to post
Share on other sites

The doctors office did try to say they weren't sure that my Optifast diet would work because it was only for 5 months and it was over two years ago (Jan 31 to Jun 6 of 2013) but I had sent Tricare an email because I wanted it in writing and they responded that there were no specifics pertaining to the duration or the timeline of the last weight loss attempt. You just have to have tried to lose.

Doctors office submitted it on a Monday in the evening, Tricare reviewed it on that Tuesday and needed the doctor to clarify if it was inpatient or outpatient. They clarified and when I called Wednesday am it was approved.

Share this post


Link to post
Share on other sites

I did things on my own with weight watchers over a years time and lost 80 pounds but wasn't being followed by my doctor at the time. Also a few times he prescribed me meds to lose weight but but not a whole lot happened with it. So now what!?!? I have really nothing to show.

Right now I'm getting too close to the cut off with my BMI. It's 36 right now with my last weigh in. I last got weighed in I was 197 but then she had me take off my shoes and I was 196 something and she took it to 195 cause they round it. I'm only 5'1. I can't afford to lose anymore before the sleeve or I won't get it. I'm very bottom heavy. I carry it al below. It was my pcp who referred me. Wonder if that would help ... All these questions I still have

Share this post


Link to post
Share on other sites

I'm super excited for you!!! Your time is going to go sooooo fast!!!! That's just a couple weeks from now!!!! Wow! And from what I see in the picture you are so pretty! You've been a wealth of help for me and I truly appreciate it a lot! Where are you from? I'm in Pittsburgh. My husband is in the Airforce so I'll be getting this done at a regular hospital and not at s base hospital. I'm so super excited for you!!!! Please let me know how you do and message me! I'd love to keep in touch with you if you'd also like to!

Dawn

Share this post


Link to post
Share on other sites

Get the bypass with tricare. It's worth it.

Thanks for your input Txn26!! So glad you are super happy and feelin good! Us Tricare peeps need to stick together! ????

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

    • Eve411

      April Surgery
      Am I the only struggling to get weight down. I started with weight of 297 and now im 280 but seem to not lose more weight. My nutrtionist told me not to worry about the pounds because I might still be losing inches. However, I do not really see much of a difference is this happen to any of you, if so any tips?
      Thanks
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
      · 0 replies
      1. This update has no replies.
    • KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • 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.
  • 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

    ×