Tricare Standard & Their Requirements

[donnad0118 13]

Hi Everyone...I am new here and have been reading through many of the boards. I know that Tricare has just recently added the gastric sleeve to their approved procedures and wanted to see if there was any new information from people who have used them. I have my first consultation next week and I am curious at how long they require documentation of weight loss. Is it 6 months or 3 months? I see so many conflicting answers and the website does not specify. I have Tricare Standard North (Tricare Reserve Select to be exact). The surgeons office told me today that their average wait from first consultation to surgery is about 12 weeks. That leads me to believe that it is only 3 months?

Anybody have any recent experience with this?

Thanks in Advance!!

[erivan 2]

Hi! I'm also having the gastric sleeve done with Tricare Standard South and just received my preauth today! I'm also 5'8 and 270 lol.

With Tricare South I've paid my deductible of $150 plus nutrition classes which were $300. I've also had some out of pocket here and there for things that I have to pay a percentage on so so far out of pocket I'm at about $600 I would guess. That's over the 6 months because it is a 6 month evaluation. I didn't have to do a diet because if I dropped under a BMI of 40 it would deny my surgery. I've pretty much stayed this same weight the whole time. I didn't have to submit any previous history because I have high blood pressure so the comorbidity helped me I guess.

I'm scheduled to have surgery on March 13th but I'm still trying to find out what my total out of pocket will be for the actual surgery. I have a max of $1000 cat cap for myself so that's all I should have to pay but I've called and gotten 5 different answers :-/

My experience with Tricare has been pretty great. I just had a tubal in preparation because my dr said you become very fertile and because of my blood pressure and history, I've never been able to take birth control. That surgery probably incurred costs that will go towards my cat cap as well so I'm not sure how much I'll end up paying out of pocket in the end.

[donnad0118 13]

Hi! I'm also having the gastric sleeve done with Tricare Standard South and just received my preauth today! I'm also 5'8 and 270 lol.

With Tricare South I've paid my deductible of $150 plus nutrition classes which were $300. I've also had some out of pocket here and there for things that I have to pay a percentage on so so far out of pocket I'm at about $600 I would guess. That's over the 6 months because it is a 6 month evaluation. I didn't have to do a diet because if I dropped under a BMI of 40 it would deny my surgery. I've pretty much stayed this same weight the whole time. I didn't have to submit any previous history because I have high blood pressure so the comorbidity helped me I guess.

I'm scheduled to have surgery on March 13th but I'm still trying to find out what my total out of pocket will be for the actual surgery. I have a max of $1000 cat cap for myself so that's all I should have to pay but I've called and gotten 5 different answers :-/

My experience with Tricare has been pretty great. I just had a tubal in preparation because my dr said you become very fertile and because of my blood pressure and history, I've never been able to take birth control. That surgery probably incurred costs that will go towards my cat cap as well so I'm not sure how much I'll end up paying out of pocket in the end.

Thank you so much for the info! I, too, am right at that 40 BMI and was curious how that would play out. I know I have seen some others who had to lose weight and if I did it would make me not qualify. I do not have a comorbidity, that I know of. I am borderline hypertension and I have never been tested for sleep apnea. I am sure they will send me for this test though. I go tomorrow for my first consultation with the surgeon, so I pray all goes well and I hear some good news.

I didn't realize that you became more fertile after the surgery. I had a tubal back in 2009, so I am good there. I thought the cap was like $1000 or $1500, but I could be wrong. Guess we will both find out soon.

Let me know how everything goes. It would be great to keep in touch with someone with the same stats as me.

Best of Luck to you!!!

[bbk95 15]

I have prime and I was told I have to do 3 months of pre-op things

Sent from my SAMSUNG-SM-G935A using the BariatricPal App

[LatteLinguist86 0]

Hi! I have Tricare Prime South. I'm in the MacDill area. I'm going in to talk to my PCM today and praying she will give me a referral to see a surgeon. I have a friend in Michigan (military spouse) who just got approved for everything and waiting on a surgery date. She said the time frame was 3 months to document weight loss attempts and then get all the testing done. So she's around the 6 month mark, but it took her a while to actually find a surgeon in network.

[HD Girl 4]

I have prime west. I really do think the pre-approval process in individual specific. I had my initial consult around the same time I had to have a total hysterectomy so it did take a little longer for me. My OB/GYN had to clear me. Once cleared, and all other pre op stuff was done, my surgeon's office sent it off and less than a week later, I was approved. I did not do any weight loss program before.