Tricare anyone?

[rglad1267 6]

Just starting this journey- actually waiting for the surgeon's office to call me with an initial appointment. I was wondering who out there had Tricare insurance and how difficult were the hoops you had to jump through? I am nervous that even though my bmi is 40 I will be denied and honestly, I don't know where I would go from here. Background: 52 year old female, don't drink, don't smoke, GERD is my only comorbidity.

[KishaG 61]

I have tricare! It was actually much easier than I anticipated. After my surgeons office got my referral their ins coordinator called me. She told me that tricare would approve based on BMI over 40, I could have even been approved at a 35 simple because of sleep apnea. Ohh how I wish I knew that a few years ago.

Tricare requires a 4 month weightloss trial, the ins coordinator told me tricare does not actually require you to lose weight just to basically answer yes to all the questions -are you parking further away than needed - are you putting your fork down between each bite etc. I scheduled all 4 of my appointments to be at approx the same time and I fluctuated just a little down, up down.

During my 4 month wait I had my first appt with surgeon to decide which surgery to have and had my nutrition class as well as my individual appt with dietician.

After my last weight appt the end of June, I had to wait for a few more tests to come back for the surgeon, they came back the beginning of July and they submitted my packet to tri-care. Less than a week later I was approved due to timing for someone to be with me after surgery I couldn't have my surgery in July even though it was offered. I finally had it done on Aug 19.

Now the difference is I do have sleep apnea and high blood pressure but again, my insurance coordinator told me just being over 40 bmi was enough. I would talk to your surgeons insurance coordinator to see what they say hopefully you are still in a Mil area where they are all accustomed to using tricare and their rules. That made it so much easier for me.

The process went really really quickly for me and I was terrified tricare would randomly deny me. We are tricare prime retired and even with that I was approved.

GL and if you have any questions just message me, I will answer them to the best of my ability.

[Charlessmott 0]

Hey All
Just wondering if there is anyone from Canada that has travelled out of country to have the PN decompression surgery. Just looking for experiences etc.

Thanks Julie

[MeowAMR 219]

I have Tricare, but my situation was a little different because the Army Base here in San Antonio, Tx has a bariatric clinic. So I wasn't required to do any dieting for any amount of months. I started my journey as in dietitian classes, blood work ups, upper gi, psychiatric evaluation, sleep apnea evaluation in April and had my surgery in July. I got it so quickly because the military clinic's don't have to jump through as many hoops as if you go through a civilian provider. But being at a 40 BMI you don't need any comorbidities. I was a 40 BMI and my comorbidities were PCOS and sleep apnea. I'm sure you'll get approved just because of your BMI.

Sent from my SM-G965U using BariatricPal mobile app

[PlanetHopper 86]

I am also using Tricare for my surgery. I did have to have three months of the supervised diet from my surgeon, a psychology evaluation (2 appointments), blood work, barium swallow test (because I am getting the Sleeve), and a nutritionist appointment. My BMI is 36 pre-op and and I do have depression and chronic pain as commodities. I honestly don't think you will have any issue with getting approved I can update this post to let you know what happens with my approval.

[rglad1267 6]

Thank you everyone! Had my initial visit yesterday and my surgeon's office said there is a 6 month waiting period with weight checks by my PCM but they saw no reason why I wouldn't be easily approved!

[seelesgo 0]

I have 37 BMI and Tricare doesn’t list chronic pain or PcOs as comorbidities and they are testing me for sleep apnea (which I’m not sure I have) ... I’ve already started the process so I’m not allowed to gain weight (to get to 40 BMI - nor would I want to.)

Any tips on getting this thru Tricare with an approval of surgery given the above?

After years of ups and downs... this feels like my only chance for a long lasting solution... I’m so afraid of a denial

[seelesgo 0]

@planethopper did you have any luck with your approval?

[PlanetHopper 86]

35 minutes ago, seelesgo said:

did you have any luck with your approval?

Hey there, I did. I was approved and has VSG on 12/9/19. Are you going through a military bariatric program or a civilian bariatric program? I believe this may make a huge difference. I moved away to a different state and no longer see my surgeon for follow ups. I see a medical assistant from a bariatric program run by the military hospital. I am sure that if I would have moved here before the surgery, the program would not have allowed me to do it.

My comorbidities were major depressive disorder and chronic back pain.

[seelesgo 0]

19 minutes ago, PlanetHopper said:

Hey there, I did. I was approved and has VSG on 12/9/19. Are you going through a military bariatric program or a civilian bariatric program? I believe this may make a huge difference. I moved away to a different state and no longer see my surgeon for follow ups. I see a medical assistant from a bariatric program run by the military hospital. I am sure that if I would have moved here before the surgery, the program would not have allowed me to do it.

My comorbidities were major depressive disorder and chronic back pain.

So I’m going thru Tricare Prime and Loma Linda Bariatric program (because the base we are attached to does not have medical facilities.) my husband retires next year and I’m praying to get surgery scheduled and done this summer before school starts for my daughter in August. Since there is a good chance I’ll be homeschooling.

So if I’m understanding your response, you went thru a military medical facility?
Is there a way to message directly via this app - id love to know more about your experiences.

[PlanetHopper 86]

12 minutes ago, seelesgo said:

So if I’m understanding your response, you went thru a military medical facility?

The opposite. I went through a civilian bariatric program.

I sent you a message