Tricare Prime confusion

Hi! Im new here and Im in need of some guidance. I have Tricare Prime North, and Im wondering what the requirements are to be approved for gastric bypass. I was told that you have to be at least 100lbs over your ideal weight and have a co morbity (i have hypertension and pre diabetes and im only 22..) so i meet that requirement. Im in Milwaukee and I was told  by my PCM that I needed to be on a 6 month medically supervised diet (which ive been on since december) but when I called Tricare to make sure I was doing everything right, they said that they dont require the diet and wont cover it and that all i need is to meet the weight and comorbidty requirements.. im so confused. So my question is is does that mean I dont have to do it? Or since thats what the surgeon wants ill have to pay out of pocket? Ive heard many different things about getting approved with Tricare Prime, I hear its the insurance thats easiest to get approval from. Someone I used to work with had Tricare Prime and she got the approval and everything and had her surgery within 4 months. Any insight would be greatly appreciated!!! Mandy

You're right, Tricare doesn't require you to have a 6 month diet.  Does your PCM know that.  You might want to mention that at your next appt.

I was just approved on Thursday from Tricare Prime. I did not have to do a 6 month diet to get approved.  Is it the doctor that wants you to do the diet? My nutritionist had me do a month diet before she cleared me to see the surgeon so my blood glucose would be lower. And I've continued with that. But as for Tricare Prime, the diet isn't needed. Good luck! Cindy

Mandy, My wife and I both had gastric bypass last April.  We were not required to do a 6 month supervisory diet.  All we had to do was show them different diets we'd tried in the past.  It was so easy getting approved.  We went to an information meeting, then set up an appointment with the surgeon.  When we met with him, he said you're a perfect candidate.  We had to do the nutrionist consult, psych testing, fitness center brief, one support group meeting and a second meeting with surgeon at which time he scheduled our surgery.  It was almost like we didn't have to get it approved by Tricare.   It was very effortless.  From the time we started the process, it took about a month to get all the consults done and about 6 weeks total until time of surgery.  If you have any other questions, let me know.  Good luck. Floyd