Tricare??? Anyone???

I used tricare standard for my bypass

Then sent my approval letter in the mail so that was the longest part but my hospital called them and I found out I was approved within a week. Just had to wait for the letter

Edited January 20, 201610 yr by LoseItKacy

I used tricare standard for my bypass

Then sent my approval letter in the mail so that was the longest part but my hospital called them and I found out I was approved within a week. Just had to wait for the letter[/quote

That's fast! I'm happy for you!!! I hope your doing well and happy with your bypass! How far out are you?

I know for sure Tricare allows bypass but it's brand new that they are approving the sleeve. And with that there are a bunch of stipulations for approval.

Thank you for your post LoseItKacy! ????

I called Tricare today and gave them the CPT code for the surgery and yes it is approved...the sleeve surgero????

Tricare??? Anyone???

Hi, I have tricare prime. My husband is currently active duty military. Tricare won't pay if you have the sleeve done off post or at a cilivan surgeon, however, I am lucky enough to have a on-post surgeon who does the sleeves.

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

Hello Cladd, my husband is active duty Navy. As you know, we have Tricare prime. I had the sleeve done Dec 30, 2013. And BC of almost 2yrs of a stricture and acid reflux, I had to have a revision to GBP on Dec 4, 2015. Unless something changed recently, they pay for the sleeve. Hope this helps and sorry if this is a repeat answer, I didn't read the entire posts. Good luck:)

I was approved by Tricare Prime as a spouse within 24 hours. My BMI was 37 and I had high blood pressure. I also submitted a year of failed Weight Watchers documentation. I was nervous about being approved. I had gastric bypass on 12/21/15 as at the time they did not pay for the sleeve. I would not have changed my decision to get bypass in hindsight either.

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

Hello Cladd, my husband is active duty Navy. As you know, we have Tricare prime. I had the sleeve done Dec 30, 2013. And BC of almost 2yrs of a stricture and acid reflux, I had to have a revision to GBP on Dec 4, 2015. Unless something changed recently, they pay for the sleeve. Hope this helps and sorry if this is a repeat answer, I didn't read the entire posts. Good luck:)

Thanks so much for your answer! It was not a repeat post and thanks forctsking the time to answer me. Sorry you had complications with your sleeve! That's terrible. Hope you are doing well now

Thank you everyone!!!! The sleeve is a covered surgery!!! I'm thrilled. My only hang up now is I don't have any doctor documents stating I had failed weight loss in the past???? I mean I went to my doctors for follow ups and Med refills and referral requests but never to have continued weigh ins for weight loss. I did weight watchers one year on my own and went from a size 18 to a size 4 all on my own but wasn't paying for weightwatchers. I had the points booklet from someone and used that. Looks like I may be in a pickle

Just send all the requirements to Tricare, now I'm waiting for respond!! How long does it take to respond?

Just send all the requirements to Tricare, now I'm waiting for respond!! How long does it take to respond?

I got mine in two days. Well it was submitted on a Monday at around 3pm and approved on Wednesday at 9:49 am. I know because I called at 7:45 am and it was still pending. But I got impatient and called again lol. Good luck!!!!

Hi,

My surgeon's office told me today that Tricare North requires 6 months of documented weight loss efforts within the last year. Does anyone have experience with this?

My BMI is over 40.

Thanks!

I just had my apt with the surgeon today. He said 3 months over the last two years. I am in TriWest. It could be the surgeons retirement?

It's probably the surgeons requirement. Also a lot of other health plans require 6 months so they might just be saying it as default. I posted the word for word letter I received from Tricare where they stated that there was no set duration required. I didn't have one. I started my process in December and my surgery is 2/1. Literally 4 days from now. I had done a liquid diet in the past (2013) for almost 5 months and they accepted that.

I had the sleeve December 17, 2015. I was just told today by my surgeons office that Tricare is going to retropay for the gastric sleeve all the way back to September 2014. They will be submitting the claim. Has anyone else heard this or been reimbursed? If so, how long does it take for the reimbursement? I'm so excited! Too bad I bought a supplemental insurance plan for complications through my surgeons office.

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

Something changed with Tricare between October 2015 and this month. Sleeve was on the exclusion list which is why I didn't get it done last year. I just noticed a couple weeks ago it's now covered. See http://www.tricare.mil/CoveredServices/IsItCovered/BariatricSurgery.aspx - Also, I called and verified my benefit coverage with Tricare for procedure code 43775 (Gastric Sleeve In-Patient) and they gave me all the copay, etc. Anyone with Tricare should check it out.