Who has Tricare Prime and advice?!

I got my referral to see a bariatric surgen and went to the seminar at Palmetto health center here in SC. Have my first appointment with my surgen for the RNY Aug. 11 to set up all the appointments for the requirements like nutritionist, dietician etc...I am 5'4 280lbs. No co-morbs, although I do have PCOS and am on Metformin for that. Do you think tricare will approve my case in these cir****tances? Any experiences would help give me some peace. Also, how long does everything take? Thanks for all your advice! :)

 Hi!  I just had surgery 5 weeks ago, and have Tricare Prime.  I was 5'4 and 299 when I started my journey.  Because you are 100 pounds or more overweight,  Tricare should approve you for surgery.  When the Tricare nurse called me with the approval, he explained because I met the over 100 pounds for my height, that automatically qualified me for surgery.

The whole process with Tricare was super easy.  Just make sure you do everything up front the doc asks of you, and it should go smoothly.  My entire process from begining to end was less than 3 months from when I met my surgeon.  It could have been shorter like 4-6 weeks,  but I needed to have surgery on break from school.

Good luck!  Hope everything goes well!  

Thanks for your response Amy! Did you have your surgery done on base or off? Also, did you have to do any 3-6 month documeted dieting? How are you doing with your new lifestyle? I wish you the best of luck!

HI!  I had my surgery off base at  one of the best hospitals in Southern California.  I didn't have to do a 3 or 6 month diet - actually Tricare denied that request for the nutrition classes from my doc.  Then my doc submitted a request directly to the bariatric surgeon and it was approved within days. 

I love my RNY!!!  Best decision I have ever made.  This has been a blessing to me.  Im down 40 pounds in 5 weeks.  Life continues to get better every day.  Sometimes I forget I had the surgery,  as I haven't had any issues at all.  Life is good!

You may find after your testing, etc that you have a comorbidity that you weren't aware of.

If you have any further questions,  Please feel free to contact me.

Good luck!

Ok I have Prime BUT my case was a bit different. It has taken me four years (do not let that scare you, as I said mine is different). I was at fault for the failures previously.

Now this year I started doing everything back in February. Did all the requirements- then my surgeon left the MTF I was going to have my surgery at. I got transferred out and had more requirements for the surgeon I have now. Once I got the last three things completed they sent my letter in. They sent my letter in on July 12th, I was approved THAT friday (15th), got a call in the 18th, had my last IN office pre-op appt on the 19th. Got my date of August 29th. So once the ball gets rooling and you stick to it, you should be ok. Now as for the weight and comorbs- PCOS is not one of the comorbs for tricare prime.
these are what it says on the tricare prime site for requirements:

• 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)

I'm so happy that you got your date for surgery! Long time comming!! :) I knew that PCOS is not a Cmorbs but was hoping since I was on metformin, it would help. Also my BMI is documented at 47. I am having my surgery off base. I pray that this is a 3 month wait and not years...bless your heart! Thank you for sharing your story and best of luck to you!!

I have Tricare Prime and had high cholesterol, hyperinsulinemia, and hypertension. These co-morbs that were enough to approve my surgery. That being said, it was the PCOS that I had that caused my co-morbs. I went thru an MTF and the bariatric coordinator would only send approval requests once all of the requirements were achieved. From start to finish, my timeline was 15 months, BUT my surgeon deployed to Afghanistan during that timeframe. Otherwise, it could have taken as little as 6 months to complete the pre-op program that my surgeon required.

 Tricare only requires that one be 100lbs over weight.  I however wasn't, but I had HBP, diabetes, high cholesterol, gerd, sleep apnea and of course all the aches and pains with being 5'2" and 210lbs. My PCM put in for a referral in Nov of '08 and was approved by Mar 0f "09.  Long story, but finally got my surgery Nov "09.    

This is for the poster above me------
actually they made a few changes to their policy.
this is right off the website....

• 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  OR 
•  
• Is 200 percent or more over ideal weight for height and bone structure  OR 
•  
• Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown)

*edited because my pc decided it didnt want to copy and paste right......*

I have tri care prime North.  The requirements change according to your region.  I had to do 6 months supervised diet. It took me about 8 months from start to finish.   As you go through your pre op testing you may find you have more more co-morbs.