TRICARE AND WLS?

I've read the other posts... And they have been really helpful... I currently have Tricare Prime... And in my experience Tricare has been difficult in the past. I live on maui and there is no Military Facility on the island. Does this this mean that I will have to go to Oahu to get the procedure done? Are there any surgeons on Maui that can do the procedure? I currently have a BMI of 41 point sum thing or other. In the other posts it says you HAVE to be at 40 or higher. Do I need additional problems or is that high enough? FUNNY thing is I NEVER thought I would have to worry about not being HEAVY ENOUGH !! LOL !! How do I go about getting appovel for the procedure? My PCP just laughs off any topic about WLS... I am only 19 and she says I can just work it off, but the thing is I CAN NOT! I've tried EVERYTHING from Weigh****chers to plain ole' STARVATION. I think I can live off of water for the rest of my life and still be heavy! :P Do I need her to refer me or can I apply with out her refferal? Any help with WLS in Hawaii would be great specially' with TRICARE as ur insurance.

Sorry... Such a long post one last thing ... Abdominoplasty, or Tummy Tuck... Does Tricare cover this at all? Maybe a portion? Hummm... Like I said i'm 19 so in about 1 year and 2 months my Tricare Coverage will expire and then ... I'm outta luck Any help would be great!!

I didn't have my WLS in Hawaii, so I can't help you much there. But Tricare did pay for mine, 100% and the hardest part was waiting to get to the top of the wait list. I had mine done at Madigan at Ft. Lewis Washington by a wonderful surgeon. Your first step, is to get your PCP to give you a referral and if he won't, change PCP and ask the next one. Without the referral there's no chance of getting the surgery. Make sure you tell your doctor you're serious, and that you really want the referral. Don't let him put you off about getting it. I don't understand doctors who won't give the referrals, afterall it's not their decision whether or not you get the surgery, it's yours and the surgeons. Last I checked their rules were a BMI of 40, if lower then that you had to have several comorbids. Since you're over 40 you should meet their standards. The downside is how long you have insurance left, I spent 9 months on the waiting list to get my surgery and know of people who waited over 2 years. Now since there's no MTF where you live you may be allowed to go to a civilian provider. Not sure about that since I had mine done by a military doc at a military hospital. Good luck! I'm getting ready to start my plastic surgery process with TriCare and it already sounds like I'll have a fight on my hands. ~Tanja

I am Tricare Prime also, and I live on the island of Oahu. I just talked to my PC Doc today and she told me that the BMI is 30 - 40 with underlying morbid health problems. (Diabetes, heart disease, etc.) Over 40 BMI, you do not have to have the additional health problems. Now, when I spoke to my previous doc, here on the island, last year -- she told me that it's really hard to get in here, as they have a limited number of plastic surgery docs. (Though that still makes no sense to me, as I know for a fact that the plastic surgery docs have nothing to do with the Lap Band or GB surgery. You see, my hubby works in the operating room here at Tripler!) Of course, this lady was not the most sympathetic woman either... she basically told me to suck it up and just lose the weight. Like I never have tried. *rolls eyes* My current doc told me she was referring me over to someone about the surgery and wanted me to speak with them about my next step. She also told me that if there was no availability at Tripler Hospital, then I could be referred to the Network. (Which would be non-military docs.) My doc also told me that Tricare covers the surgery and the plastic surgery (excess skin removal, etc) 100%. It's cheaper than them paying for all of the medical problems that can eventually occur from the weight as I age. (And, since my hubby is a lifer, I guess they would be paying for whatever may come!) I can't offer you more info, as I haven't received much more, at this point. Feel free to email me if you want though. [email protected]

Hi Cyndi, I forgot to mention in my e-mail to you, all of the docs that can do bariatric surgery are all deployed. Dr. Segan left at the earlier part of this month. You may need to start looking for a surgeon in the Triwest network. I will be flying to San Diego for mine. The nurse at Tripler that handles the referrals named Jeff in the General Surgery office I found to be unsympathic and insensitive and just generally NOT very knowledgeable about WLS in general so be forewarned! Dr. Balfour does the surgery on the island but his wait list is 9-10 months and he only does the OPEN procedure. If you want the Laparoscopic done you will need to be referred out. Let me know how it goes! And if you run into any snags just contact Terri Cloud with Tricare patient Benefit Counseling (Patient Advocate) and she will get things moving along for you. She did for me! Best of luck to you! Stephanie

I also have Tricare Prime....I was on a waiting list in Virginia, where the MTF would NOT refer you out to a civilian, so I waited for over 2 years....in that time, my husband got new orders for us to move here to Hawaii....all I did was went to my new PCM (she is at Tripler, and absolutely wonderful), and told her I needed a refferal we had just PCS'ed out here...she gave me the refferal, Tripler called, and said the surgeons were deployed, so I could either wait for them to come back, or I could go to a civilian...on this island there is ONE civlian surgeon who accepts Tricare...he wasn't accepting new patients....so, I got back on the phone with Tricare, and told them they needed to figure something out because there was NO WAY I was waiting another 2+ years again, and then possible PCS AGAIN and not ever get the surgery done....and, my husband is deploying in the summer, so my time was REALLY limited...I needed to have the surgery done no later than this spring....they completely understood---LOL, finally....they gave me the names of 3 surgeons in CA...I researched them all, and I chose Dr Clark, and my surgery is scheduled for Feb 21st--YAYYYYY.....we just have to pay out of pocket for the travel expenses because gastric bypass surgery is still considered an elective surgery. As far as the skin removal stuff afterwards....when I was on the waiting list in Virginia and went through the orientation program, they said after you lose all your weight and have the excess skin, if you go to your PCM THREE times and say you keep getting rashes under the skin, Tricare will cover most, if not all the expense of getting the skin removed. Now, I have no clue if there is any truth to that out here, but I am fully prepared to give it a try no matter where we are stationed at!!! I would definitely be persistent with your doctor, and if she is laughing at you, I would be switching providers. It really sounds like she/he doesn't want to help you. Good Luck to you though!!!