Recent Posts

Thabitis_Wife
on 8/24/09 12:31 pm - Norcross, GA
Topic: RE: Tricare and Pre-OP Requirements

I had to pay out of pocket for the nutritionist but not the psych eval.  I know it stinks but hopefully your insurance company can reimburse you.

Kathryn92
on 8/24/09 10:41 am - Atlantic Beach, FL
RNY on 03/15/10 with
Topic: Tricare and Pre-OP Requirements
I am going through a civilian surgeon, and have been to the seminar and my first appointment with the person that works with Tricare to get me approve. My question is, at this appointment I was told that I would have to pay for my psych eval and nutritionist out of pocket.  Has anyone else had to pay out of pocket?
Ms. Cal Culator
on 8/24/09 8:39 am - Tuvalu
1Blessed4life
on 8/17/09 4:44 pm, edited 8/17/09 4:46 pm
Topic: Almost approved, now moving to Germany!
I have been going through the process for surgery with all the tests, referrals, evaluations, labs, ect. and finished everything except I had 2 more visits with the Nutritionist when her contract with the military clinic was not renewed. Now waiting to see if they will give me a referral for a nutritionist off base. I was hoping to be totally cleared and then we got orders for Germany! Now I hear that I have to start the whole process all over again. Anyone in Germany now with good news? Excited for our new adventure...

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 HW: 260 / SW: 254 / CW: 140 on 01/15/13 Orig GW: 150             ~Jeremiah 29:11  

Wendi W.
on 7/21/09 5:23 am - Waukegan, IL
Topic: RE: Tricare/Triwest covered vs not covered
Tricare Prime - North Region.  Here is the information you need, along with the steps you may need to take, but verify with Tricare first.

Gastric bypass, gastric stapling, gastroplasty, and vertical banded gastroplasty are covered. Laparoscopic adjustable gastric banding is covered effective February 1, 2007. (view Hospitalization Costs):

The following conditions must be met:

  • The patient is 100 pounds over the ideal weight for height and bone structure and has one of these associated medical conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints; or
  • The patient is 200 percent or more of the ideal weight for height and bone structure, regardless of associated medical conditions; and
  • InterQual® criteria is used during the authorization process to determine if the requested surgery is appropriate and medically necessary. (InterQual® is a widely used product of McKesson Corporation that provides evidence-based clinical decision support for health plans, hospitals, government payors, and various other organizations.)

Authorization Requirements
TRICARE Prime beneficiaries require prior-authorization for all non-emergency inpatient procedures. 

The following services are excluded (this list is not exhaustive):

  • Office visits solely for the treatment of obesity
  • Non-surgical procedures for treatment of obesity
  • Biliopancreatic bypass (jejunoileal bypass, Scopinaro procedure) (CPT codes 43645, 43845, 43847 or 43633).
  • Gastric bubble or balloon
  • Gastric wrapping/open gastric banding (CPT code 43843)
  • Unlisted CPT codes 43659 (laparoscopy procedure, stomach); 43999 (open procedure, stomach); and 49329 (laparoscopy procedure, abdomen, peritoneum and omentum).
Depending on what level of service you have, you will need a referral from your PCM (primary care). 
Wendi

   
       
 
Robin O.
on 3/1/09 8:29 pm - Sheppard AFB - Wichita Falls, TX
Topic: RE: Tricare/Triwest covered vs not covered
I just came from Triwest and went through the whole process but not surgery and I never had to pay out of pocket for anything.  I never seen that anyone was paying out of pocket for anything.  I am hoping it will be the same way here just with better Drs here so I can actually get surgery doen this time.
rinaalston
on 2/4/09 1:17 pm - LANCASTER, CA
Topic: RE: Newbie here

Welcome to the board.....I felt the same way about asking the PCP about a referal too....I'm a armywife and we live near a AirForce base so I didn't think they would do that for me and they did....I got my referal in less than 7 days and everything has went so stressfree on the end of tricare....They have been great. So do your research now and when you PCS in march make your appt. at the base and ask for it ASAP so when you get to PCS again you will look and feel great!!

Redhaired
on 1/19/09 10:16 pm - Mouseville, FL
Topic: RE: Tricare/Triwest covered vs not covered
The RNY should be covered by Tricare no matter where you live as long as you meet the weight and co-morbidity requirements. 

Red

  

 

 

Redhaired
on 1/11/09 4:22 am - Mouseville, FL
Topic: RE: Newbie here
I hope it goes well for you.  Are you hoping to have your surgery before you PCS?

Red

  

 

 

Renee_mom2_5
on 1/9/09 1:02 am
Topic: Newbie here
Hey there,

I just wanted to pop over, now that I know there is a military support board and introduce myself and say "Hi". My sweet dh has been in the Air Force for almost 10 years now, we have been married for nearly 13 yrs, and have 5 kiddos (3 girls and 2 boys) whom we homeschool. I have been thinking about/reasearching WLS for about 5 yrs now. I have decided that this is going to be my year to try and start the process. I would have liked to try so many times in the last 3 yrs but I have put it off because of fear or intimidation of the PCP's here on base. I have never really been treated with respect in a base clinic except by a OBGYN, or civilian Dr. However, I just need to get over it and move forward. We are PCSing in early March to NE and I am excited for a new start. I have one friend who had WLS years ago and now I am hoping to *meet* some new ones, and learn as much as I can.

Blessings,
~Renee~ 
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