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Insurance Tricare?

claddagh66

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notquiteajock    0

notquiteajock
Posted

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.

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claddagh66    132

claddagh66
Posted

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

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claddagh66    132

claddagh66
Posted

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.

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prettyCali916    299

prettyCali916
Posted

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.

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claddagh66    132

claddagh66
Posted

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!!!!????????????????????

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prettyCali916    299

prettyCali916
Posted

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????

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prettyCali916    299

prettyCali916
Posted

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! :)

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prettyCali916    299

prettyCali916
Posted

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".

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prettyCali916    299

prettyCali916
Posted

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.

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claddagh66    132

claddagh66
Posted

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

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claddagh66    132

claddagh66
Posted

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

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claddagh66    132

claddagh66
Posted

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! ????

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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