Tricare dilemma!!
You should be OK with a 40, just don't go below it until you are approved! Make sure you use everything you can think of in your medical history - rashes, depression, stress incontinence, joint and spine pain, high blood pressure, etc. Most insurance companies just want more than one co-morbid if you are between 35 and 40 bmi. Good Luck!
Tricare approved me and I was 40.5 going in. I have lost some weight due to pre-op diet and am now down to 38. I didn't have all of the major co-morbidities that go along with being overweight. I actually thought Tricare would deny me. I do have arthritis in the hands though so don't know if that helped me or not. I have back pain, pain in the weight bearing joints and GERD. My PCM thinks I may have sleep apnea but I have never been tested for it. He actually wanted me to come back next week and see about having a sleep study. I am having surgery on June 25. Overall, I found Tricare to be very easy to work with. I was approved in less than 2 weeks. Good luck and keep me posted!!
Angela
Hi Sandy,
I have Tricare and had my RNY on June 4th.
Tricare doesn't necessarily go according to BMI. They go by 100 lbs over ideal weight with A co-morbidity -OR- 200lbs over (or 2x) your ideal weight without a co-morbidity.
Do you see several doctors *****commend this surgery for you? If so, have them write a letter for you.
It's also in the hands of your surgeon who writes that final letter of request to Tricare.
To speed things along, I contacted Tricare Case Management and got in touch with the Transitional Care Nurse who approves/denies authorizations here in RI.
You can do the same by calling 1-800-977-7961.
Also, Tricare requires a Thyroid blood test prior to approving your submittal! There's nothing on any of the Tricare or HealthNet Federal Services sites that say this. They want to rule-out problems with your thyroid so make sure your PCP or surgeon sends you for this immediately.
I hope this has helped in some way. Good luck to you.
Jules
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