RE: Getting Approved

I was wondering how hard it is to get approved. I am getting ready to go to my educational class August 16th. I am wondering if Tricare gives you a hard time. My doctor said that sometimes Tricare can be a pain, but it can be done. I am starting to get worried about it. I have really bad back pain so my doctor said that my back pain will aid in me getting approved.

Hi there and WELCOME!!! What is your BMI and do you have co morbidities? Usually you have to have a BMI of 40 with co morbidities or be 200% of your ideal body weight. I had no problem with approval. After my paperwork was submitted, it took about 24 hrs!!

My BMI is 43 and I don't even know what co morbidities are. My ideal body weight is 150 and I weigh 279.

Do you have high BP or diabetes? What about sleep apnea? Things like that are comorbidities. It will be hard to get approved with a BMI of 43 alone.

I don't have any comorbidities. I do have chronic back and knee pain. My PCM said that it is because of my weight. He said he is going to try to push that to get the WLS approved.

i do wish you luck and PLEASE keep us updated!

Hi Kandy and Welcome! Tricare goes by 200% of your ideal body weight if you don't have any co-morbidities. Tricare uses Metropolitan Life's table to determine ideal body weight. Here http://www.halls.md/ideal-weight/met.htm is the ML table. So the 150lbs you have been told is probably high (luckily for us wanting WLS). I'm 5'8 had to be over 272lbs, I was 278lbs at my consult with my surgeon and once my packet was submitted, I was approved by Tricare within 48 hours. Hope this helps and good luck!! Andi

My doctor and his insurance girl said that Tricare was really good to work with and usually have an approval within 24 hrs. My BMI is only 42, but I have several comorbidities. I have an asthma nurse that calls me monthly from Tricare. She says I really need the surgery and thinks it will go through without a problem. We'll see. my paper work was suppose to go in last Friday, but they didn't get everthing ready for her. She said it will probably take her until Friday to get it all in. So, I will know more about it by next week, hopefully. Everything we have done through Tricare Prime has gone very smooth. And Tricare for life is even easier. She said they are starting to go by the BMI. Which has to be over 40. Do you have arhthritis in your back? That is a comorbidity. Diana

My BMI is 39 and I have Diabetes and HP. My packet was submitted to Tricare last Thursday and I was approved on Tuesday. Good Luck!

This is supper!!!! This ought to be encouraging to many out there. Congratulations!!! Diana