Tricare??? Anyone???

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

If your BMI is under 40, Tricare needs proof of comorbidities like maybe diabetes, high blood pressure? I think they need two. It's on the Tricare page. When my doctor did my intake form he said that I was in pretty good health but that he was going to check the box for "joint pain and arthritis" because I dislocated my knee cap in 2012 and it was still bothering me. Other than that I didn't have any, however my BMI was 46. I'm very bottom heavy too. I wear a 18 in pants but a Large in tops. It's always been like that. My dresses are 16's because 18's would be so big on me up top so I just don't wear them anymore unless I wear thighs or leggings with them. I know you're struggle of being bottom heavy!

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

You're so sweet Dawn! Thank you! I will definitely keep you posted! I'll add you as a friend on here - I think I have to go to my laptop to do that but I'll definitely keep in touch. My husband is active duty Air Force as well and we are in California.

Well I didn't go there to be weighed in. I would go for Med refills and neck issues and back issues etc and be weighed while there. Since he's the one referring me to do this I'm sure he would write s letter or something stating we did stuff in the past. His system switched from paper to electronic so he said he doesn't have apt of his past history stuff Ugggh. So I'm going to see if he will write me something.

So far I've had an EKG, EDG, (endoscopy), sleep study, mamo, pap, (gyne stuff) psych eval, I still need a stress test and the second over night sleep study which I'm doing tomorrow night. Other than that I've done everything!

If he talked about your weight during those appointments it might work. If you can print out your weight watchers payments or even get them to give you your weigh-in history that might work if you were seeing the doctor and discussing weight during those times. If not, you might need to start now - meet with him and weigh in. Tell him what diet you're on - and then meet for two more months and do the same thing. They should take it based off of three months of dieting and medical supervision. I hope it works out for you! You have done everything else! I forgot about all the gyno stuff because mine was still current from last year. And you know what, if you want to try having the doctor submit what you've done it won't hurt, as long as you're ok with possibly being denied. You just have to make sure that if they do approve it you're ready mentally to handle the new way of life that comes from the sleeve.

Oh - I was able to copy the email that Tricare sent me. Here it is:

Aloha,

Thank you for your question. The TRICARE Policy Manual does not specify a certain number of months that the beneficiary must have been unsuccessful under a supervised weight loss program, however, there a other clinical considerations that are provided as guidelines:

TRICARE Policy Manual, Chapter 4, Section 13.2 states:

__________________

4.0 POLICY

4.1 Bariatric surgery, using a covered procedure outlined in paragraph 4.2 is covered for the treatment of morbid obesity when all the following conditions are met:

4.1.1 The patient has completed growth (18 years of age or documentation of completion of bone growth).

4.1.2 The patient has been previously unsuccessful with medical treatment for obesity. Failed attempts at non-surgical medical treatment for obesity must be documented in the patient's medical record.

4.1.2.1 Commercially available diet programs or plans, such as Weight Watchers®, Jenny Craig, or similar plans are acceptable methods of dietary management, if there is concurrent documentation of at least monthly clinical encounters with the physician.

Note:These programs are not covered by TRICARE.

4.1.2.2 Physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.

4.1.3 The patient has evidence of either of the following:

•A body-mass index greater than or equal to 40 kg/m2.

•A body-mass index of 35-39.9 kg/m2 with one clinically significant co-morbidity, including but not limited to, cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy, or pulmonary hypertension

___________________

Bariatric surgery for morbid obesity requires prior authorization from the managed care support contractor whose clinical reviewers ensure that TRICARE coverage criteria can be met based on accepted medical practice.

I hope this information is helpful.

Aloha,

Gertie F

TRICARE Regional Office West

Hawaii Operations

I think you're medication for weight loss meets the 4.1.2 requirement!

Thank you so much for the information. Can anyone recommend a good surgeon for the sleeve strings Raleigh to Fayetteville area?

I have Tricare standard and had the bypass on 12/16 I completed all steps to get my surgery within 3 weeks , I also have BCBS Federal under my dad so I didn't have any out of pocket fees besides the $120 for my nutrition session and $25 for pshy eval. I have no regrets of getting the bypass I have lost 30 lbs in 4 weeks which I think is great considering I was 223 the day of surgery so I thought I would be a slow loser.

Hello! Could you tell me what the psych eval is like? Thank you! :-)

I don't have Tricare, but I did have a similar requirement from my insurance provider: failed attempt at weight loss under doctor supervision. When I decided I wanted the surgery, I didn't have that in my medical records. So, I got it:

1. Arranged monthly meetings with my doctor where she counseled me about diet & exercise, checked my weight, and wrote this all up in my chart every month;

2. Failed to lose weight (this is not hard . . . if I am an expert in anything, it is in failing to lose weight. I wanted the surgery, so I put extra effort into failing, and failing hard).

3. Submitted to my insurance provider and got approved within 24 hours.

Yes, it slowed down my process, but that's okay. I did a lot of research on post-sleeve life and actually did build habits that would help me, such as logging everything on myfitnesspal, not eating and drinking at the same time, etc., even as I failed in other aspects of weight loss.

Good luck!

I had the sleeve done in Oct. 2015 and have Tricare Prime. I had a BMI over 40 with no comorbidities. Our Mtf program required the 4 hr seminar, colonoscopy for over 50; a mammogram and pap for females; barium swallow; a pysch eval; 3 nutrition classes and 2 support group meeting attendance.

Hello! Could you tell me what the psych eval is like? Thank you! :-)

Hi! I had my psych eval a few weeks ago and it was so simple. It lasted about 1/2hr to 45min. He asked me questions like who lives with me, what do I do for a living, do I ever get depressed,and if so how do I handle it, do I drink, smoke, drugs, what are my fears and strengths. Basically that's about it. He asked will I have any support if I decide to go thru with the surgery at home. Honestly I thought it all was a big waste of time. It really had nothing to do wit the surgery at all. I think it's more to make sure your in a sound mind and not all over the place with thoughts. You'll do just fine. Trust me. I told him my fears were of drowning and seeing people struggle under water. It was a very simple process. Right afterwards I met with my PA and NUT to continue my visit. Good luck to you!

I am in Boise. I have Tricare Prime. The sleeve is being covered. I just confirmed with my doctors office.

I have Tricare standard

It doesn't Matt if you are standard or prime they will still approve it. The only difference between prime and standard is how much you pay and what doctors you see. In prime you have to go in network. With standard you can choose but you might have to play more. I was a insurance biller at Landstul in Germany so I am really familiar with insurances. Let me know if you have any other questions.

Sorry I am on my phone matter and pay

It doesn't Matt if you are standard or prime they will still approve it. The only difference between prime and standard is how much you pay and what doctors you see. In prime you have to go in network. With standard you can choose but you might have to play more. I was a insurance biller at Landstul in Germany so I am really familiar with insurances. Let me know if you have any other questions.

Sorry I am on my phone matter and pay

Thank you so much for your input! I was really worried when I was hearing we weren't covered! I guess now it's just a matter of making sure of what all they require for sure. Thanks again Lindsey!

Thanks to all for your input!

Thank you so much for the information. Can anyone recommend a good surgeon for the sleeve strings Raleigh to Fayetteville area?

Hillbillienurse, I would ask this in its own question on the forum. If you create your own topic then it will get noticed by many more people and you'll get so many more answers that way. (Just a thought). Good luck to you!! We will be moving to the Fayetteville/Wilmington area in 3 years!!! I can't wait. As soon as my husband retires from the Airforce were leaving Pittsburgh!