Tricare Standard

Hi All,

Just wanted to say it only took 2 working days to get an approval back from Tricare Standard.  Wow, that was a surprise!  We had no problems working with Tricare, what a relief. Just an fyi for all of you wondering about T.S.
Have a great day,
Mary Ann

Hi, I am looking into the surgery and I also have tricare standard, I was wondering if you know if you have to a specific disease associated with obesity, or if they take into account other diseases describes by the surgeon? 

This is from the tricare website.

Gastric Bypass

TRICARE covers gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery) is covered only when the beneficiary meets one of the following conditions:

• Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints
• Is 200 percent or more over ideal weight for height and bone structure
• Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown)

Okay...question....I have had ups and dowsn with my blood pressure for 4 years, I got a copy of my records today and there were a couple doctors visits where my blood pressure was okay, but I had many more visits where my pressure elevated, about 2 years ago I was on bp meds but I had neg side effects so I discontinued using them. Today I had a complete physical and of course my blood pressure was up again.  So I guess my question is, will tricare deny me just bc I had a few visits with normal bp, or will they take into consideration my history of ups and downs with it, also what is tricares formula for figuring if a person is 200% more than their ideal weight? Or is that something that my physical tells tricare of do will tricare have to determaine that on their own just by looking at my records.  I was also wondering gestational diabetes is consiered a type od diabetes with tricare bc I am at am extremely hish risk for developing type 2 diabetes....ah so many questions, tommarrow is the seminar, then I can get my first consultation, so nervous, and scared!

I don't have Tricare yet, however it will be our insurance in the 'next phase' of my husbands career so I have been manically doing research.  Because I am not only compulsive about my food, but about research and information as well.

I would speculate that the 200% of body weight, is targeted for people who would be less than 100 pounds overweight, but still twice what would be considered healthy.  Say someone one who is 5 feet, or less than 5 feet tall.  They don't have to be 100 pounds overweight to drive a greater than 40 BMI.  

I believe that Tricare will take into account your medical history.  If you are denied, then you have the ability to appeal and list out all of the health reasons you have provided here, as why the surgery is right for you.

However, as stated above.  I don't have Tricare yet and I am not traveling my WLS path, with Tricare as my insurance provider.  They will however be the people doing my follow up care.

Hi, I have Tricare Standard also. I've been denied for the DS as they don't cover it. I've also been denied for the RNY as I don't weigh enough. They said I had to be 100 lbs overweight of the mid-way point on the Met Life scale. My BMI is 37 and I have a lot of co-morbidities. Good luck!