tricare prime

 Just got denied by tricare prime. after five months of testing. I have a BMI of 42.5 and GERD and sleep apnea. Would love to hear from anyone who won an appeal with Tricare. I am so bummed.

I had them 9 years ago when I had my VBG.  They didn't deny me and my BMI was about the same as yours.  Did they give a reason for your denial? Cathy

Oh honey, don't give up!!!  That is what they want you to do.  Remember, you want this and you deserve it - so don't let them tell you no!  What does your surgeons office say about this? Tonja

Can you change to Tricare Standard? A friend of mine had to. Then she was approved.

Hi there, I have Tri-care prime and was approved at the first try, along with the paper work that my doctor at Reynolds Army Community Hospital send, I also made use of the letter that is here online and edited to my needs.  Now Tricare doesn't look at the BMI but at the acually weight, meaning you have to be at least 100 pounds overweight with an additional condition…below is from the Humana handbook

 

 

Gastric Bypass

Gastric bypass, gastric stapling, or gastroplasty—to include vertical banded gastroplasty—is covered when one of the following conditions is metrate:   The patient is 100 pounds over the ideal weight for height and bone structure and has one of these associated medical conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders, and severe arthritis of the weight-bearing joints.   The patient is 200 percent or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category.   The patient has had an intestinal bypass or other surgery for obesity and, because of complications, requires a second surgery (a takedown).