Tricare question....

For those who have Tricare (Prime) , when you were approved for your surgery, did you have any co morbidities? I am reading on Tricares website that you have to either be 100lbs WITH a co morbidity OR be 200% over your ideal body weight. I don't have any co morbidities but I am also not 200% over my ideal weight. I am, however, 200lbs over weight. Does anyone have any insight on this? TIA! Erica

I have Tri Care prime and I was approved in 2 weeks. The reason it took so long was because of the Dr's office not sending the correct paper work in. I didn't really have any co morbs that were life threatening (high blood pressure, diabetes) but I did have aches and pains caused from being over weight. ( back problems, heel spurs) and a few others. Just write down everything that bothers you from being over weight and put it all together in a letter. Good luck and I'm sure you'll have NO problem with getting approved.

Thank you so much! I have everything done, (all my testing and such) and my paperwork is getting ready to be submitted, i am just so worried something will go wrong. I am going to work on my letter to tricare and let them know why this suregery is right for my and why I NEED it. Erica

You can also tell them about any immediate family members with diabetes etc. They counted those for me.

You will be fine as long as your doctor, a base doctor, approves it or refers you for surgery. I was standard, went and changed to Prime, and then made an appt at the Naval Hospital. I just went in and said I had an appointment with Dr Byrne on the 10th of May or whatever it was, about 2 months out....so go ahead and make that appointment first, so you are not waiting for MONTHS and I just told the doc that I had to have a referral, and he wrote it. It took about 2 weeks to get to the main Tricare office, and it took a lot longer to get the actual surgery approved because I had a prior stomach surgery that had to be reversed, to do the RNY, but the doctor who approved it finally said that "she is going to die if she doesn't get it, and if she does get it, her chances are better". Dr Byrne was called by him a ton of times and he wouldn't talk to the guy, so since I kept calling Tricare and talking to the nurse referral person in charge, they approved me. My case was really high risk, so that is why it took longer. Once they approved it, it was a matter of days. I had my surgery date before I was actually approved, so don't think you have to go the opposite way. If you take the first step and make your appointment, it will take you a while to see Dr Byrne. He is one of the top gastric bypass doctors in the country, like #4 I think. He is awesome. By the way, you DO have co morbids....I bet you have joint pains, and bad back pains and problems breathing when you climb stairs. No way you can be 200lbs overweight and have nothing. Anyway if you get my drift........you tell the Military Doc who writes your referral you have lots of joint pain in your knees and back, hips, etc... and lose your breath when you walk, etc.....those are co-morbids. Your blood pressure is probably higher now too, than if you were 200lbs less, and if they want you to do lots of tests, I didn't, I did do some bloodwork, but after I got my referral, I never went back as I was standard and had my own primary care doc at MUSC. He let me pay cash and charged me like nothing to have my pre ops done and appointments. I also became diabetic that summer while I was waiting on surgery and I went on meds, which is all now gone. Go read my story on my profile, and it should help you...I think I have phone numbers posted there for Tricare, etc... make sure they fax your referral to the right place as they faxed all my stuff to the wrong number, which was half the hang up... I stayed on top of Tricare, and they were always in the right, MUSC, Joyce, kept losing my stuff and not doing things right, but I think that is changed now. Anyway YOU ARE GOLD with Tricare, just take the upper hand and YOU TELL them what you want ;) Get your appt first, and just go in. When they called with my referral, I told the girl I already had my appt with Dr Byrne, so they said, "Okay" we will put his name in request. God Bless, this is the best thing you will ever ever do for yourself!! I now weigh between 142-146.....I always bounce around those pounds....I want to lose just 10 more, even though I am 10lbs underweight, because of my acting, 10lbs added on camera. Deb

If you have a BMI of 40 or more then you do not have to have a co morbidity to be approved through Tricare...If you have a BMI of 35 then you need to have a co morbidity to be approved.

TRI CARE PRIME IS VERY EASY TO GET APPROVED FOR GASTRIC BYPASS SURGERY ... YES, THERE IS THE 100# OVERWEIGHT RULE, BUT IF YOU HAVE SERIOUS CO-MORBS, THERE ARE TIMES WHEN THEY WILL CONSIDER 80#s OVERWEIGHT ... IS YOUR BMI (BODY MASS INDEX) OVER 40.0? (Go to near the bottom of my profile & check your BMI on the "FIND MY BMI" fill-in screen). THAT IS ANOTHER WAY THEY VERIFY THAT YOU ARE OBESE. YOU CAN USE YOUR FAMILY HISTORY AS A BASIS FOR YOU PROBABLY GETTING SERIOUS CO-MORBS IN THE FUTURE. IS YOUR FAMILY OBESE? DO THEY HAVE THE KINDS OF MEDICAL CONDITIONS THAT CAN BE ASSOCIATED WITH OBESITY? CO-MORBS ARE JUST ABOUT ANYTHING THAT YOU CAN ASSOCIATE WITH OBESITY ... DO YOU HUFF & PUFF WHEN YOU WALK? DO YOU EXPERIENCE NECK & SHOULDER PAIN FROM YOUR BRA STRAPS DIGGING INTO YOUR SHOULDERS? DO YOU HAVE JOINT PAIN WHICH IS PROBABLY CAUSED FROM OBESITY RELATED ARTHRITIS? DO YOU "DRIBBLE" WHEN YOU SNEEZE, LAUGH OR STRAIN? DO YOU HAVE PROBLEMS HAVING SEX DUE TO YOUR WEIGHT & SIZE? ARE YOU LIMITED IN WHAT YOU CAN DO WITH YOUR CHILDREN, LIKE NOT BEING ABLE TO PICK THEM U*****T BEING ABLE TO RUN AROUND & PLAY WITH THEM? DO YOU HAVE A LOW SELF-IMAGE OR ARE YOU DEPRESSED? DO YOU HAVE TROUBLE PERFORMING TASKS AT WORK? DO YOU HAVE PROBLEMS WITH RELATIONSHIPS DUE TO YOUR WEIGHT ISSUES? HERE IS AN OLD LIST OF CO-MORBS ... YOU JUST HAVE TO GET CREATIVE IF YOU DON'T HAVE THE TYPICAL HIGH BLOOD PRESSURE OR CHOLESTEROL, DIABETES OR SLEEP APNEA ... NOT ENOUGH CO-MORBs?????? Original Post by Lady D * at 10:05 AM PST on 09/15/2005 Summerville, SC - RNY (10/28/2005) I'M A BIT HEAVIER THAN MOST ON THIS BOARD, BUT YOU NEED TO REALLY GET CREATIVE WITH THE CO-MORBS IF YOU ARE A TRUE "LIGHTWEIGHT". MY DR HAD TONS OF WEIGHT-RELATED ISSUES ... HERE'S WHAT I CAN REMEMBER ... NORMALLY YOU NEED A BMI OF 40 & BE 100 #s OVERWEIGHT, BUTTTTT ... DO YOU HAVE - DIEBETES - HIGH BLOOD PRESSURE - HIGH CHOLESTEROL - ACID REFLUX, HIATAL HERNIA, REGURD DISEASE, SEVERE HEARTBURN - FLUID RETENTION OR SWOLLEN JOINTS - ARTHRITIS, DEGENERAGIVE BONE DISEASE (ESPECIALLY IN THE LOWER BACK) - LARGE BREASTS = RUTS IN YOUR SHOULDERS (NERVE DAMAGE FROM THESE PRESSURE POINTS FROM THE BRA STRAPS) ... SHOULDER, NECK OR UPPER BACK PAIN ... HEADACHES OR SEVERE TENSION AT YOU NECK/SKULL - RASHES UNDER YOUR BREASTS OR STOMACH OR BETWEEN YOUR THIGHS, ETC. - CARPAL TUNNEL SYNDROME (SECONDARY CO-MORB) - HEAVY MENSTRUAL FLOW (SECONDARY CO-MORB) POOR BLADDER CONTROL ... DO YOU "SQUIRT" WHEN YOU LAUGH, COUGH, GET UP OUT OF A CHAIR, ETC - SLEEP APNEA ... SNORING, COUGHING, CHOKING, APNEA (STOPPING YOUR BREATHING) - SEVERE PAIN/DAMAGE IN ANKLES, KNEES & HIPS - EXHAUSTION ... TAKE NAPS DURING THE DAY OR NEED TO RECOUPERATE AFTER ANY PHYSICAL EFFORT ... NEED TO REST DURING LONG PERIODS WALKING LIKE WHEN SHOPPING LIFESTYLE LIMITATIONS ... - LITERAL HUFFING & PUFFING PERFORMING "NORMAL" DAILY ACTIVITIES - LIMITED OR UNABLE TO PERFORM NORMAL FAMILY ACTIVITIES - " " " " PERFORM SEXUALLY - " " " " PERFORM EMPLOYMENT DUTIES - NEEDING HELP BATHING, TYING YOUR SHOES, DRESSING, TAKING CARE OF YOURSELF ... WHAT HAVE I MISSED LADIES GOD BLESS DAWN & NICK RE: NOT ENOUGH CO-MORBs?????? Response from Karen P at 6:45 PM PST on 09/15/2005 Erie, PA - Amjad Ali, M.D. Hi Dawn, That was a great list. The only other one I can think of is hyperlipidemia (I think that's it) high lipids. You always have great posts. Karen RE: NOT ENOUGH CO-MORBs?????? Response from Andrea B at 12:57 PM PST on 09/17/2005 Slayton, MN - RNY (05/04/2005) Here are a few more that I have thought of: Depression Pain in feet (Arthritis) gall bladder issues Asthma going 2 months or more between periods Fatty/Large/Diseased Liver & ... COPD & DEGENERATIVE BONE DISEASE, ESPECIALLY IN THE LOWER SPINE ARE ALSO CO-MORBs ... DON'T REMEMBER IF I PUT THIS ON THE LIST, BUT IF YOU HAVE A WEAK BLADDER IN WHICH YOU URINATE WHEN YOU LAUGH, SNEEZE OR STRAIN YOUR STOMACH MUSCLES ... THAT'S A CO-MORB. ~~~~~~~~~~~~ LIGHTWEIGHTS" (BMI ABOVE 35 & NO MORE THAN 120#s OVERWEIGHT) ... USUALLY AVERAGE BETWEEN 80 & 100 #s OVERWEIGHT. THE BASE CRITERIA FOR WLS IS A BMI OF 40 OR MORE & AT LEAST 100 #s OVERWEIGHT. BECAUSE THEY HAVE A HARD TIME QUALIFYING SINCE THEIR NUMBERS ARE SO LOW, I PUT TOGETHER A LIST OF WHATEVER I COULD FIND ON CO-MORBS. IF YOU HAVE ANYOF THE ABOVE, YOU PRIMARY CARE MANAGER (PRIMARY/FAMILY DR) SHOULD WRITE A LETTER OF NECESSITY BASED ON THE FACT THAT YOUR CO-MORBs HAVE BEEN GETTING WORSE & THAT BY HAVING WLS, YOUR CO-MORBS SHOULD IMPROVE OR BE COMPLETELY HEALED. ALSO, LIFESTYLE LIMITATIONS CAN BE USED ... SUCH AS ... ... CONSTANT PAIN IN NECK SHOULDERS & UPPER BACK BECAUSE OF BRA PRESSURE & WEIGHT OF BREASTS ... WALKING LIMITED BECAUSE OF JOINT PAIN ... LOWER BACK PAIN CAUSING MOVEMENT & WALKING LIMITATIONS ... SEXUAL LIMITS BECAUSE OF OBESITY ... NOT BEING ABLE TO TIE YOUR SHOES (CAN'T BEND OVER FAR ENOUGH), OR DRESS YOURSEF COMPLETELY WITHOUT HELP ... or CAN'T CARE FOR YOUR FEET, TOES & TOENAILS ... NOT BEING ABLE TO CLEANSE YOURSELF PROPERLY AFTER USING THE RESTROOM (MANY OBESE HAVE THIS PROBLEM) ... NOT BEING ABLE TO CARE FOR YOUR CHILDREN PROPERLY (CAN'T CARRY OR PICK UP A SMALL CHILD, FOR INSTANCE.

Thank you everyone for your responses. I have already done all my testing and my health is excellent...even at 200#'s overweight. Believe it or not, I am VERY active and exercise regularly. It has surprised all the docs I have had to see. I like to think of myself as a healthy obese person. My paperwork is getting ready to be sent into Tricare. I have just been nervous cause I called Tricare and what they were saying didn't sound good. I need to just not worry about and wait for my approval! Thanks! Erica