Tricare
Kelsie,
Hi there! I have Tricare Prime through the North Region, so if you are in another region or on Tricare Standard there might be some differences.
But, the information I am giving you will be useful and helpful.
First thing is that Tricare does not use BMI for being approved for WLS. They use the MetLife table. You have to be at least 100 lbs over your ideal weight for your height with comorbidities, or if you have no comorbidities 200% over your ideal weight for your height. So, when you look at the MetLife table. Locate you height, then you will see three columns that say "small, medium, and large" frame. Tricare will use the "medium" frame as default, unless you have been tested.
Depending on your coverage with Tricare, you may need a referral from your PCM to see the surgeon, you may also need referrals for the psychological eval, and the pulmonologist eval. Tricare will not pay for Nutrionist/Dietician evals. But, is you use a MTF for your primary care, and they have psychiatric, pulmonologist, and a nutritionist there you can see if they can do them for you and no out of pocket costs will be incurred.
Now, you will need some tests that Tricare will require.
Full blood panel work up and will also need to include
Thyroid - TSH
Helicobacter Pylori
EKG signed off by a cardiologist or your PCM
The clearance from the pulmonologist may require a sleep study
Tricare at the time I was approved for surgery, did not require a 6 month diet. I am not sure if this has changed. But, the surgeon may require it as part of his program.
I hope this helps
Hi there! I have Tricare Prime through the North Region, so if you are in another region or on Tricare Standard there might be some differences.
But, the information I am giving you will be useful and helpful.
First thing is that Tricare does not use BMI for being approved for WLS. They use the MetLife table. You have to be at least 100 lbs over your ideal weight for your height with comorbidities, or if you have no comorbidities 200% over your ideal weight for your height. So, when you look at the MetLife table. Locate you height, then you will see three columns that say "small, medium, and large" frame. Tricare will use the "medium" frame as default, unless you have been tested.
Depending on your coverage with Tricare, you may need a referral from your PCM to see the surgeon, you may also need referrals for the psychological eval, and the pulmonologist eval. Tricare will not pay for Nutrionist/Dietician evals. But, is you use a MTF for your primary care, and they have psychiatric, pulmonologist, and a nutritionist there you can see if they can do them for you and no out of pocket costs will be incurred.
Now, you will need some tests that Tricare will require.
Full blood panel work up and will also need to include
Thyroid - TSH
Helicobacter Pylori
EKG signed off by a cardiologist or your PCM
The clearance from the pulmonologist may require a sleep study
Tricare at the time I was approved for surgery, did not require a 6 month diet. I am not sure if this has changed. But, the surgeon may require it as part of his program.
I hope this helps
Wendi
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