Tricare Prime

I have called Tricare at least 5 xs a day and they wont tell me what criteria they need for surgery. I asked them about the 6 mth diary.I seen every1 on here sayin they dont need it....but I talked to the Refural Man. and she said I have to do the 6 mth diet....WTF!!! Ive looked on the Tricare websites and can't find anything. please someone help me....where is it posted at as to what I need????HELP

Sorry to here you are going through this. I started on post with the surgery. I had to have a psych eval and I had to do nutrition class. Then after I did all my stuff I found out they are not doing them on post so I got reffered of. I know all you need to have is a BMI over 40 or 35 with 2 or more comibities. I wish you luck. Heidi

Hi Molly, Hedi is right . You just have to go to one nutrition class. Psy. evaluation...possibly a sleep study, and a couple other appointments depending on your physical condition and doctor. Some insurances do require 6 months of diet; but Tricare Prime is not one of them. Even though I have to start over again because of my husband transfering. Tricare Prime is one of the best insurances for WLS. They require a lot less , and they cover pretty much all of the costs.....what you have to pay is usually just minor expenses if any. I hope this helps. Good luck! Jaye Jaye

Your surgeon's office may require the 6 month diet? I'm not sure why the referal person is telling you that. My surgeon's office made me lose 5% of my weight before they'd submit to insurance. According to my surgeon's office all Tricare wants is my height, weight, psych eval and if you have co-morbidities any tests/proof of those. BUT my surgeon's office adds everything they require (5 year weight history, diet attempts history, sleep study, nut consult, etc) as well. Good luck! Andi

Thanks for helping. I have tried to get answers from Tricare and they would never tell me anything. My Bariatric Coordinator called and said that she finally talked to someone from Tricare and was told what you all said.Thanks...She also said that my surgeon had NO waiting lists...WooHoo....So all I have to do is hurry hurry hurry up with the tests.

Hi Molly, I'm just starting this and I'm going through a onbase PCM and a MTF. I don't know if this is everywhere, but here we have to go through a program for the surgery. We have to do a food log, a exercise program, all the evaluations, and sit through the pre surgery support groups. I don't mind doing these. I already exercise 3X's a week. I'm not good with writing down what I eat, but that won't be too hard. The Coordinator also told me that it would be a 6 month program, but that I really determine how long it will really take. I find out more on Tuesday though, so we will see. I also asked her (my coordinator) about the diet and she said that our surgeons want it, but they have made exceptions about it at times. Such as a 1 month diet, if I follow all the rules and haven't lost anything then they might accept that. I already know that their "diet" won't help because last time they put me on it I gained 20lbs. Trust me Atkins doesn't work for everyone.

Hi Molly, Sorry to hear you are having such a hard time. I started my journey with my PCP. He referred me to a surgeon then after that Ive had to get a Psych eval, nutrietion class, was told I had to attend a support group meeting, which I did last night and it was awesome I enjoyed it. But they are also making me have an ultra sound to see if I have gall stones, ekg and chest x-ray. My BMI is 42.5, and so far Ive not had a problem with Tri-care at all. Did you have your PCP to refer you to see a surgeon? just curious. To be honest Ive not once even been to the tri-care website I just went through my pcp and thats it after that I guess it got approved.

I found a surgeon and made sure he took Tricare. Then I swiched my PCP from on post to a network doc. She was supposed to put in the referal on the 6th but I called Tricare AGAIN and she said that I had a referal to a diff kind a surgeon. WTF!! I am picking my doc. Not them. She said the surgeon was for my ankles.?? My dr never said nuthin bout my ankles...just was swollen. I'm going to get my PCP to send my surgeon I PICKED a letter for authorization and my surgeon will send it to Tricare. I also seen on the website that Tricare doesn't cover the laproscopic but my surgery coordinator said that the Trcare manager said they do cover it. I don't know whats going on anymore. I know it's a big head ache. I'm gonna try to get everything fixed tomorrow. I am going to a seminar and support group meeting on the 20th. The bad thing is this surgeon is the ONLY one in the area I live and I have to see his Psych and dietician...wich I WILL have to pay for....That sucks because I have 4 kids and no $ left at the end of the month.