Tricare and bypass

[Olena808 4]

I'm in dire need of help if anyone has it. I'm so depressed and emotionally gone. Been struggling with weight my whole life and trying to get an approval to get a bypass. But my Dr won't budge or even listen to me. What have you gone thru and what have worked for the surgery to be approved.

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[Cutwater 41]

I'm retired military and have/used Tricare for my Bypass. All that was needed to get approval was a doctor that was concerned about my long term health (my primary care doctor) and I had to have at least two medical conditions that were related to my obesity ( type 2 diabetes and HBP were mine). BMI also had to be above a certain measure.

You didn't list your current weight or medical issues, so if you aren't considered obese or have medical conditions related to that, I agree with your doctor. This isnt an elective surgery, it's a lifestyle change and commitment to eating better, taking care of yourself better and ultimately loving the whole new you and lifestyle.

Good luck

[Olena808 4]

I'm currently at 211 5'1. My nutritionist recommends it being my history of my weight. I'm just wondering and curious. I know many others who got it that don't even meet anything.

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[AmyR 38]

If you don't have any other medical issues and given your current weight, I think you might be better off to look at lap-band or another WLS that is not quite as drastic as gastric bypass. Ask your doctor if he'd be willing to sign off on something else, besides gastric bypass.

[KristenLe 5,980]

Can you transfer to another Dr? Patients should be at the center of care and have a voice in their medical treatment. Find a PCP that will work with you.

[Lindsey Skinner Abbott 97]

I would request a different PCM. They are not the keepers of who get surgery. Tricare sets the standard on who qualifies for the surgery. Is your spouse still active duty? I am in Tricare prime and will be having the Gastric Sleeve next Tuesday. I would look at the Tricare website and print out the requirements for surgery and take that into the doctors appointment with you.

[Renkoss 420]

Believe it or not, Tricare is really not much different than most healthcare plans. My husband is not military, but he works for the Federal Government. Our insurance is a federal based plan, and the requirements for WLS is still the same; a BMI over 40 and at least 2 commorbidities. My commorbidities are/were Type 2 diabetes, sleep apnea, high cholesterol, metabolic syndrome, and a BMI of 49 I think?

If you have no commorbidities, even if your BMI is over 40, you most likely will not qualify.

Keep in mind as well that WLS is only a tool; you have to be committed to this lifestyle for the rest of your life. It isn't just a fad or something that will change 5 months down the road. You are altering your internal body forever. It is a huge change and not to be taken lightly. I fought for years against my doctors recommending that I have it done. My health issues got to the point that I had no other choice. I'm glad that I did it now, and wish I had listened years ago, but again, if I didn't think I could stick with it, I still wouldn't have done it. It took a while for myself to say YES, I need this now.

Edited May 17, 2016 by Renkoss

[Olena808 4]

I would request a different PCM. They are not the keepers of who get surgery. Tricare sets the standard on who qualifies for the surgery. Is your spouse still active duty? I am in Tricare prime and will be having the Gastric Sleeve next Tuesday. I would look at the Tricare website and print out the requirements for surgery and take that into the doctors appointment with you.

Wow. Yes hes still active. Could you send me the link. I def would love to put a piece of paper on her table I just request to change PCM takes effect on 21st

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[Olena808 4]

Believe it or not, Tricare is really not much different than most healthcare plans. My husband is not military, but he works for the Federal Government. Our insurance is a federal based plan, and the requirements for WLS is still the same; a BMI over 40 and at least 2 commorbidities. My commorbidities are/were Type 2 diabetes, sleep apnea, high cholesterol, metabolic syndrome, and a BMI of 49 I think?

If you have no commorbidities, even if your BMI is over 40, you most likely will not qualify.

Keep in mind as well that WLS is only a tool; you have to be committed to this lifestyle for the rest of your life. It isn't just a fad or something that will change 5 months down the road. You are altering your internal body forever. It is a huge change and not to be taken lightly. I fought for years against my doctors recommending that I have it done. My health issues got to the point that I had no other choice. I'm glad that I did it now, and wish I had listened years ago, but again, if I didn't think I could stick with it, I still wouldn't have done it. It took a while for myself to say YES, I need this now.

Oh Yea I know what I have to do. Its never a fad to me

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[Lindsey Skinner Abbott 97]

Tricare is its own animal. I work for the federal government and no, Tricare insurance is not the same as what you have in the civilian world. You only have to have one co-morbidity and a BMI of 35 to qualify. You will also need 3 months of documented weight lose in the last 2 years. If your BMI is over 40 the. You don't have to have any co-morbidity. I waited a very long time to get this surgery. Once I had everything to submit to Tricare it only took two days for them to approve the procedure. So less than two weeks after approval I will be in surgery. My surgeon did not have a two week liquid diet or a weight lose requirement prior to surgery. He is the best bariatric surgeon in my area and the clinic is a certified bariatric center of excellence. I couldn't be more excited to finally get this done after almost two years of waiting. I was a week away from surgery last year in Germany but the surgeon would do the surgery since we were PCSing in the summer. So good luck with your journey....it might be long but will be worth it!

[Olena808 4]

Tricare is its own animal. I work for the federal government and no, Tricare insurance is not the same as what you have in the civilian world. You only have to have one co-morbidity and a BMI of 35 to qualify. You will also need 3 months of documented weight lose in the last 2 years. If your BMI is over 40 the. You don't have to have any co-morbidity. I waited a very long time to get this surgery. Once I had everything to submit to Tricare it only took two days for them to approve the procedure. So less than two weeks after approval I will be in surgery. My surgeon did not have a two week liquid diet or a weight lose requirement prior to surgery. He is the best bariatric surgeon in my area and the clinic is a certified bariatric center of excellence. I couldn't be more excited to finally get this done after almost two years of waiting. I was a week away from surgery last year in Germany but the surgeon would do the surgery since we were PCSing in the summer. So good luck with your journey....it might be long but will be worth it!

Yes thank you . I switched pcms. My nutritionist and hopefully my heart Dr will put in a letter of recommendation for a procedure to be done based off my past experiences

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