Tricare??? Anyone???

Yes they recently changed policy. The sleeve is covered!

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I'm dealing with Tricare North also. I have my first appointment with the surgeon, NUT, psych, etc at the end of March. I sure hope Tricare North does not require 6 months of pre-surgery dieting!!! I want it done NOW. I did have a run-around finding a surgeon that was Tricare approved.

Any more experience w/ Tricare North?

Thanks

I am Tricare North, and even though it isn't stated in the policy that a 6-month diet/exercise plan is required, it is definitely required in NC. I am also standard. I spoke with a nurse that handles the authorization packages as well as a lead policy manager at Tricare. I was told they will kick it back denied if there isn't enough medical documentation for failed weight loss attempts, and this is covered with a 6 month plan. I hope that helps some!

Two weeks ago I was approved for the sleeve from Medicare as primary and Tricare as secondary. I started my pre-op diet one week ago and have lost 11 lbs so far and was wondering the insurance will have problems because my BMI has gone down? I still have a week to go before my surgery date. I don’t want to get to the hospital to have this surgery only to be told they can do it because I lost too much weight. My BMI was 43 at my initial appointment in January and is now 38. Does anyone think I will have problems?

About the diet plan or weight loss program, I never did one really. I am prior service and just told them that I was on the overweight program in the Army. My stuff got approved in 1 day.

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

The doc office will do it for you...

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Finally got approved for the sleeve! It only took Tricare 2 days for the approval! I had to have a sleep study done so that is what took so long to get all of my appointments done. So excited yet nervous. I have waited almost two years for this. So happy the sleeve was approved!

Congratulations! I am glad it worked out.

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Did any of you drop to tricare standard? I want to pick my WLS center?

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Did any of you drop to tricare standard? I want to pick my WLS center?

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I am NOT an expert on Tricare at all - please talk to someone who is. BUT... If you drop from Prime to Standard... Won't you have to reach a deductible and pay a percentage???? With Prime, I'm going to have to pay about $25 dollars total. If you change, I think it will cost you $$$$$$.

Let me update on my Tricare /Sleeve journey. I was APPROVED for the sleeve thru Tricare. I had to follow my surgeon's orders. I did NOT have to have 6 month diet, did NOT have to have 2 wk liquid diet prior, did not have to have sleep study (doctor's choice as I do not have sleep apnea). I did need to have the psych evaluation done. I have surgery July 8 -- in 2 days!!!

I have tricare and was accepted for sleeve. I had to do psych eval, sleep study, barium swallow, labs, seminar, support meetings. I think it just depends on your dr.

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Yes I will have to pay 1000 deductible for each fiscal year and after that is paid my understanding is that standard will cover everything fully from there on out.

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Let me update on my Tricare /Sleeve journey. I was APPROVED for the sleeve thru Tricare. I had to follow my surgeon's orders. I did NOT have to have 6 month diet, did NOT have to have 2 wk liquid diet prior, did not have to have sleep study (doctor's choice as I do not have sleep apnea). I did need to have the psych evaluation done. I have surgery July 8 -- in 2 days!!!

Is your surgeon a military or a civilian doctor?

So happy for you.

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Civilian doctor. I live too far from a base. You sure you want to have to pay $1000????

What state are you in? (If you don't mind sharing.)

I am in Hawaii. I would have to use a military hospital if I don't drop to standard. While I am not taking anything away from the doctors at the military hospital, I have always received excellent care from my pcp. I have just had bad luck with the 2 surgeries I have had and both surgeries were performed by military surgeons in 2 different states. It could just be my body and both surgeries were emergency ones, but the only way I was able to get DH on board was to go the civilian route for his ease of mind.

I just got my pcp to sign the form that the civilian surgeon needed and I go to the info night on July 13. I am very excited. I bet you are excited for your surgery. What is your bmi at if you don't mind me asking? Mine is at 40.7

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