Question:
Anyone have problems with TriCare covering you surgery
I am 37. I am 5'2 and am 225 lbs. Have a family history of strokes, heart attacks, death from these, diabetes, high blood pressure, high cholesterol. Currently I don't have alot of comorbidities but want to prevent all this above. I do have depression, incontinence, acid reflux, always out of breath, and am starting to feel light headed all the time. So what do I do? I live in Killeen, TX. — R. Sargent (posted on February 20, 2008)
February 20, 2008
My wife is 5'2" and weighs 125 and has a BMI of 25 so I would say that
your doctor will find that you are 100 Lbs overweight and assist you in
considering options for surgery, if you have a family doctor that can
confirm that you have tried to died for at least the past 6 months and
failed. Regardless, I would locate a hospital and sergeon to go to a
seminar at near where you live from this web site. Then get to a
Cartoligest about the lightheadness, as this can be a sign of several
issues that they can test and address at once. Don't delay because you do
have a family history that assumes you are in the same danger of
inherating. I can tell you I waited 62 years to finally have surgery and I
have never felt better and taken less medication in the past 30 years then
I am taking today. I know RNY WLS has added years to my life and it can do
the same for you. Bess of luck.
— William (Bill) wmil
February 20, 2008
Hey...I was almost 100 lbs heavier than you and my tricare prime doctor
suggested it to me! But I am surprized that they aren't working with you.
Ask for a different doctor and tell them EVERY ache and pain and problem
you have and your wanting to be healthy again...Some doctors just do not
believe in the surgery...and want you to try to lose it on your own. Some
make you go on liquid diets to lose 20-40 lbs...If you lose that much,
you'd already be on your way to where you would be healthier anyway. So
they might be thing that way!
Hopefully that will help (I was at Ft Hood too...but didn't have my surgery
there) Good luck!
— .Anita R.
February 20, 2008
My sister has Tricare and was looking into the surgery a couple years back
but was about 20 lbs to light so she didn't qualify but I do know it is a
covered benefit. As a matter of fact it is the ONLY weight loss benefit
they offer, which is kind of wierd. I would find a surgeon/clinic and they
can let you know what your policy guidelines are. You can always call the
insurance company yourself and see what there guidelines are as well. It
will probably be the standard BMI of 40 or more OR 35 w/ @ least 2
comorbidities. Also, possible 6 mo supervised weightloss, but you really
won't know until you ask. Just start the process yourself if your prim doc
won't refer you, although with Tricare you may have to have that referal.
Good luck!
— juliebelle0402
February 20, 2008
Here's the latest info from TriCare
Gastric Bypass
TRICARE covers gastric bypass, gastric stapling and gastroplasty to include
vertical banded gastroplasty and laparoscopic adjustable gastric banding
(Lap-Band surgery) is covered only when the beneficiary meets one of the
following conditions:
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)
TRICARE does not cover:
Nonsurgical treatment of obesity, morbid obesity, dietary control or weight
reduction
Biliopancreatic bypass, gastric bubble or balloon for the treatment of
morbid obesity
Last Modified: January 16, 2008
— Lucian2DiBone
February 20, 2008
I too had high blood pressure. breathing problems , high cholesterol, acid
reflex, and had a c-pap machine for sleeping. I also only weighed 230.
Because of the health problems I qualified for the surgery rny. I am very
happy with the outcome. you might want to talk to a professional about the
surgery, you might be surprised what they tell you. I was.
— maskipaski
February 20, 2008
Hi! I had Vertical Sleeve Gastrectomy Oct. 25, 2007. I have TriCare, but
I self paid because they would not pay for the VSG. They would pay for the
RNY (Bypass). I weighed 212 and am also 5'2" with all your
co-morbidities. They used to cover the lap-band but I don't believe they
do anymore. It is a tough decision, but research the surgeries and ask for
the surgery you want. The insurance companies are coming around for the
VSG but slowly. Tricare will also, but I don't know when. Good luck. Pat
— pjennjr
February 20, 2008
I had BCBS as primary and Tricare as secondary. They both paid off like a
slot machine! - Pat Cole
— Pat Cole
February 20, 2008
My best friend had gastric bypass with tricare. She was under 100 lbs
overweight but she has other medical issues that allowed her the surgery.
If anything else I'd ask your doctor about trying to get approved. Find out
what qualifying factors you do have. If you DO qualify by weight alone but
he wants to be stubborn and not recommend you then I would highly recommend
asking to see another doctor. That's one thing that can be good about
tricare is that you can keep pushing for another doctor and try to find one
that will positively listen to your concerns.
— USNavyProde
February 20, 2008
I just got my bill from TriCare and they covered all that my primary did
not. My doctor is in Austin so he might be one that you would consider and
they file with TriCare. His name is Dr Ganta and he is located on
Jollyville Road. Great Surgeon and great staff. I am three weeks post-op
and doing great. Good luck. You can always call TriCare if you have any
concerns, they were very helpful when I did.
— Bernadine Morse
February 21, 2008
yes, I had a problem with tricare, my dr. wanted to do a gastric sleeve [
DOES NOT INVOLVE THE INTESTINE} they denied that request but he changed it
to gastric bypass and they approved.......strange but I am now scheduled
for my surgery the 10th of March, and I am getting so excited, nervous, and
a little bit scared, but I am looking forward and not backwards.......Good
luck to all of you who are waiting, I am right there with
you........Dianepic
— dianepic
February 21, 2008
I have tricare also, in Germany and I heard it is stricter in the states
but I think it is the same. If I qualified you should. I am 5'1 and weighed
195 pounds when I was approved. I had diabetes, sleep apnea, high
cholestrol, and feet hurt like hell and I was always tired and could not
exercise without huring myself. This is my story. I had a pcp that said she
would not refer me for the surgery she wanted me to exercise and diet. I
told her I had done all of that. I went a gastric by-pass support group
which you can find out where one is from the hospital and asked the ladies
what pcp refered them for the surgery. I went to tricare changed my pcp had
my first visit and was referred for the surgery. That was in November and I
had my surgery on February 15, 2008. Sincec January the 14, 2008 I have
lost 17 pounds. they want you to try and loose what you can before surgery.
I was on a two week liquid diet before surgery. Tricare also started
covering the lap band on February 1, 2008.
— lisa-b
February 21, 2008
Hello, I could not get tricare to approve my surgary at first but it was
because I was trying to go off base if you live near a base they will only
cover you if you go to the base to have it done. I did not have any
comorbidities and the navy hospital is doing my surgary on the 3rd of March
now. Anyway good luck and keep trying.
— raine605
February 22, 2008
Hi, I had the lapband done in aug of 03 in texas and Tricare covered that
surgery, I didnt have any problems with the approval process, I am now
having a revision to RNY because of slippage and erosion issues, my surgery
date is 2-27-08 and we didnt have a problem with getting this one approved
either. My husband is in the navy and we are in Willow Grove PA. Good luck
with your process. Dee
— Dee J.
February 23, 2008
I had my surgery at Eisehnower Army Medical Center on Ft. Gordon GA - I
didn't have to go through Tricare at all - I saw my PCM, he referred me to
the Bariatric Surgery Center - I waited about a month for that appointment
and had my surgery 5 weeks from my first surgical appointment. I was 5ft
1in and weighed 210.5 lb - I had feet problems and slightly high
cholesterol but no true "comorbidities" - Good Luck. Joanna
— machre
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