Those with Tricare (TriWest)

My question is, what is Tricare looking at when they approve/deny your WLS? I know the requirements shown on their website (100lbs over ideal body weight with a co-morb or over 200% of your ideal body weight) and the handbook (over 35 BMI with co-morb or over 40 BMI). But are they looking at anything else? These are my surgeons (additional) requirements: 5% loss of excess body weight Psych eval Nutrition eval Sleep Study 2 Information Classes My other question; do I have to wait and do all of my surgeon's requirements before my surgeon can submit to Tricare? Or can he submit it any time as long as I meet the "over ideal body weight"/"BMI" requirements? Thank you,

I'm sorry. I don't know anything about Tricare.  About your second question, I submitted the information packet that my surgeon requires everyone to fill out last week. Last Thursday, my dr's office mailed all of my records to my surgeon. Just now I received an e-mail from my dr stating that they will be sending letter of medical necessity to my insurance co. tomorrow.  So far, I have not completed any evaluation or seminar that my surgeon requires, but I have registered for the next seminar. My insurance co. also requires 6 months of doctor superivsed diet attempts from the last 24 months. I didn't go to the dr consecutively, but I do have 6 months of visits to the dr for my weight. I'm praying that they'll accept those visits as my 6 months of dr supervised diet attempts. I really think when your surgeon submits your information to your insurance co. is up to him.  I don't know if that helps, but I like to help anyone I can because Lord knows I need help, too! Karen

Hi Karen! That is what I'm thinking and hoping that the surgeon won't need me to be done with all my appointments with him in order to submit my requested to my insurance. Thanks again for all your help!!

Hi Andi, According to my Tricare Prime handbook, you must have a co-morb to qualify if you are not 200% over ideal body weight...that is also what I was told when I started my approval process.  Having a BMI of over 40 alone will not qualify you.  I had gastric bypass 3 months ago.  I had no co-morbs and a BMI of 42.  I was approved based on chronic pain in my weight bearing joints.  I read your profile and you say you do not currently have co-morbs, in fact you're starting out pretty much where I did.  Make sure you tell your surgeon everything, all complications that you have because of your weight and hopefully you'll be approved.  Tricare does not require any additional studies or evaluations, that will come from your surgeon. I can't answer your 2nd question, my surgeon didn't have any additional requirements.  Good luck on your journey and I hope it works out for you.

Thanks Denise!! I figured as much. I've seen so many insurance comments that say. "I got approved so easy. All you have to be is over 40BMI and you are approved!" But I knew (in my gut) once I read the 200% requirement that I'd have to qualify with that. Thanks for responding. I guess I'm just getting a little too impacient.  lol