Question:
Tricare patients, over here!!!!!

Hey fellow Tricare patients! I have a question. I live in Louisiana but I assume that Tricare Prime is the same anywhere you go. With that said, my surgeon's office handed this paper out to Tricare patients at an informational meeting. This paper says: (first there is a direct copy of what is on Tricare's website requiring the person to be 100 pounds or more overweight with an approved co-morb or 200% of their ideal weight, etc.) then it says: In addition to the aforementioned Tricare requirements, Tricare Prime patients are to provide 5 years of documented morbid obesity along with at least 1 6-month, doctor supervised diet attempt. All other diet attempts will be considered but at least one must have been documented under a physician's care. THIS IS REQUIRED BY TRICARE. Okaaaaay...but I was under the impression all I needed was to be 200% of my ideal weight or 100 pounds overweight with approved co-morbs (or be having a revision, but this doesn't apply in my case.) So I'm stumped. I have some of that stuff...but only have 3 years documented obesity and although I have done many, many diets none have been supervised by a doctor that I recall. So does this mean I don't get the surgery? When did the above criteria start applying? They never required that stuff before, you know? Has anyone been approved, especially those approved this year or last year, that can help me understand this? Did any of you need this stuff? And by the way, I looked on Tricare's site and none of this stuff is listed beyond what they've always asked for. It wasn't even been under the benefits update link or anything. That crud isn't listed once on there. I am so confused. Help me, please!    — jenn_jenn (posted on August 5, 2003)

August 5, 2003
I think I answered this on another of your posts, but here goes. I just had my surgery 5/23 and also have Tricare Prime. I did not need to document 5 years of obesity but did have to document all of my attempts at dieting and all comorbidities. Tricare does require you to be at least 100 pounds overweight with a BMI over 40. My BMI was only 41 but I squeaked by because of my comorbs and a surgeon who writes great insurance letters! My advice would be to document EVERYTHING and have as many records to give your surgeon as possible. Good luck.
   — MomBear2Cubs

August 5, 2003
wow, im tricare prime and i never had to deal with anything like that here in virginia beach. i got my referral, got my pre op tests done and my psych eval, and then i waited 2 weeks for approval!so it is not the same where ever you are, i know 3 other people with the same doc i had and we never had to go thru any of that. sorry, maybe you should be in virginia beach. i dont understand why the guidlines arent truly the same every where, its all crazy. shelly
   — shellypoe

August 5, 2003
I agree with whoever said to check it out with Tricare. I do know that while I was going through this whole process with Tricare that the rules were changing. I was denied surgery for not having enough physician supervised aggressive attempts at weight loss, so it very well may be one of there new rules. Check with someone at your Tricare service center and have them show you and give you a copy of the new policy if it is indeed a new policy. I did have surgery on 7-17-03 so I just recently went through this all.Tricare is no different in different regions the only difference is who and where your information is authorized the benefits are the same.
   — S C.