Tricare help!

 Hey everyone. I was looking to talk with other military wives. Or just some advice from some of you. I have Tricare. Today I went to my orientation meeting and I was told that since I had to lose right at 100lbs I am borderline for whether or not they would approve me. I'm scared now to go through all of this just to be told that it wasn't approved. Has anyone else had 100lbs with no co-morbidities and been approved? I'm really nervous about it now. I thought I would leave the meeting feeling confident and now I don't know what to do. I appreciate any and all advice. Thanks in advance.

I haven't been approved yet, but I'm right there with you. I have 97 lbs to lose, BMI 37.8, and I have BCBS FED.  I have done everything they want me to do except my last visit to my PCP on 12 Sept. and that same day my NUT appt.  I was told the same thing - lightweight and no Diabetes or high blood pressure (Being checked for sleep apnea) I may or may not be approved.  I decided to go ahead anyway. I would rather be told NO than to not try at all.  I am placing a LOT on this...I REALLY want this surgery, but I can't afford it on my own.  I have to do something.  If I wait until I am BMI 40 and older I will have more issues than I already have (back pain, hip pain, incontenence, asthma) and I will probably need plastic surgery (beyond what I will need for my tummy) as well. It's worth the risk to me. (However I am praying for an APPROVAL!!) :)

 I think I am going to move forward as well, and just hope for the best. I might call tomorrow and just ask what they think the odds will be. I feel like if I am obese, then I need to do something about it. And I'd rather do it now then years down the line when I could afford it, and I am 40 or 50lbs heavier. If I could do it on my own I would have by now!

 You have to be 200% over your ideal body weight. If you are a 100 pounds you need to have at least one co-morbid. Here is the info from the Tricare site.

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)

TRICARE does not cover:

• Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction
• Biliopancreatic bypass, gastric bubble or balloon for the treatment of morbid obesity

Note for Active Duty Service Members: Bariatric surgery represents a major and permanent change in your digestive system that requires strict adherence to a specific dietary regimen that may interfere with operational deployment. A history of bariatric surgery is already a bar to military service and receiving bariatric surgery while on active duty may be grounds for separation. For more information, view the Health Affairs Policy 07-006.

My BMI was right at 40 with no comorbidities and I was approved with no problems. (I have Tricare Prime and am getting the sleeve at an MTF.) As it turned out, the sleep study determined that I have severe sleep apnea (I was shocked...I didn't think I had any sleep issues at all) so now I do have one.

GL!

 Just so you know if you're going to an MTF it didn't go through Tricare. . .  Basically being seen at an MTF means you follow their rules not tricares.  But great job being approved through the MTF.  I am to at Bethesda.

I'm getting my sleeve  at Bethesda too. (Or the new Walter Reed...whatever it is going to be called now. ;) ) I've heard great things about Dr Lin.

I didn't know that about the difference between doing the surgery through an MTF being different from just going through TRICARE. That is interesting. I've had to do almost all my pre-requisites outside of the MTF so TRICARE has been involved a little bit.

 

 Yeah having the pre stuff done means they are involved for paying for that portion but they get no say in whether you have the surgery or not, that is up to Dr. Lin and his team.  It's one of the reasons I fought so hard to get my husband to stay in this region.  I'm only just voer BMI of 40 with no co-morbidities so I knew if I was going through tricare it would be risky.

The way it works is if you are being treated through an MTF for anything really it never sees Tricare.  But as soon as it isn't MTF then it goes through Tricare.  Its sorta nice for Dr. Lin because they get to set up their rules (like you only have to see the dietician 3x) and any weight loss after initial acceptance doesn't count against you.  I found out through tricare that if I saw the dietician for 6 months and then fell below the 40, I'd be denied!!!  I mean what sense does that make.  

I just started all my pre-op stuff but I already have all my appointments booked (except the last 2 dietician ones), my first WLS support group meeting is on Tuesday in Waldorf.  I'm hoping to be able to get through this stuff and get my surgery for January, Feb at the latest as we are PCSing AGAIN (we just moved here May 1) in May.

Tricare actually has new rules now. It isnt on the tricare websites, but it is in the tricare policy manual as of 8/17. The policy is supposed to be on the tricare sites in a week or so from now but it is actually on the Tricare Management Activity website under the tricare policy manual. It is based on the 35-39 bmi w comorbidities and 40 and over without any comorbidities needed.

http://manuals.tricare.osd.mil/DisplayManualPdfFile/TP02/145/AsOf/TP02/C4S13_2.PDF


I believe this is the page that can give you the new information.

I went to the seminar in Bethesda at the end of April and was hoping to have the surgery during the summer but ended up having to be out of town for most of the summer. So things got delayed a bit. All I have left of the required pre-op stuff is one more support group meeting (which I'm going to in Woodbridge next week; I live on Belvoir) and the final nutritionist appt on Tues. I do have another sleep study on Oct 2 to get fitted for the CPAP. And then the gastro found I had an ulcer (but no h. pylori) during the endoscopy in Aug so I'm not sure how that will impact things.
I am hoping to get the surgery done towards the end of October. We moved back here last summer (met and married here 8 years ago) but my husband will probably retire after this job and we'll stay in the area. I will be very happy to stop the moving. :)