Question:
TriCare Prime and qualifying for GP

My husband will be ARMY active duty as of May 10th; therefore Tricare prime will be my insurance provider since right now i am 5'2 and 250lbs my BMI is around 43, i was hoping someone could tell me about their experiences with TriCare and qualifying for GB. We think we'll be station in Fort Gordon, GA so if anyone has any advice on a PCP i would appreciate it.    — Yanelys83 (posted on March 19, 2006)

March 19, 2006
Hi my husband went active in Aug of 2005 I started trying to get approved for the rny gastric bypass in Oct and I had my surgery in Nov. It took approx 15 days for tricare to approve me. The only thing they asked for from was if I had sleep apnea which I did have a very mild case of it so they approved me. My bmi was 53. Good luck Tricare is pretty easy though.
   — ree

March 19, 2006
My experience with Tricare Prime has been nothing but EXCELLENT!!! My PCP on base, (We are USAF Retired, living in Idaho btw) referred me in December of 2005, I had my first consultation January 30 2006. I am also, 5'2", weighed 246 at the time, with a BMI of 45.7. My co-morbidities are hypertension, joint pain, high cholesterol and anxiety, all of which are being controlled by medication. I also have a family history of diabetes and I had gestational diabetes with my last pregnancy 10 years ago where I had to take insulin. My surgeon that I met with considered me an excellent candidate for WLS so I gave him the go ahead to seek approval from TriCare. He then ordered a psych eval, (which I had to pay partial coverage since TriWest only covered 1 hour of the 3 hour test), Ultra sound and MRI for my abdomen to see if I had gall stones, (covered completely by Tricare and they did find gall stones), Cardiology exam and stress test, (completely covered by Tricare with a 12.00 co-pay) and he had me see the nutritionist he deals with, and that visit was out of pocket since Tricare did not cover it. All of those evaluations took place in February!! Out of pocket costs was around 225.00 for nutritionist and partial pay of psych eval. Since they found gall stones, my surgeon ordered the surgery for the removal, which took place March 8, completely covered by Tricare. 1 day after my gall bladder removal, his office staff called to tell me that my approval for the gastric bypass was recieved by their office and I could schedule my surgery anywhere between 28 March thru 4 April!!!! I'm due for surgery 28 March 2006!!! Talk about whirlwind! I'm ecstatic about the care that Tricare Prime has treated me with! I have also been informed that they will cover tummy tucks and breast reduction following goal attainment. How lucky are we to be taken care of like this? I was active duty Air Force for 7 years and was by my husbands side for 14 of his 20 years of service. I have no complaints by our healthcare that has been given to us. I wish you the same luck I have had with Tricare. Please feel free to email me if you have anymore quesions or would just like to chat about your experiences! God Bless ! Sandra Sessions
   — Sandra S.

March 19, 2006
Hey. Just to let you know that everybody does not have an "easy" experience...I was denied, then I appealed and decision was overturned and I now have a date of April 7. In order to be approved with Tricare Prime you must be at least 100 lbs over your ideal weight with a qualifiing co morbidity (high blood pressure, sleep apnea, type II diabetes, picwikian syndrom) OR be 200% (2x) your ideal weight with no co morbidities. Tricare uses the most recent met life chart to obtain the numbers used to determine ideal weight. Having said that according to your current weight and height you should qualify with being 200% over your ideal body weight. As far as finding a PCP I would assume you will be assigned one once you are stationed, we usually are. Or you can do a search on this website by clicking on peers and see who from Ft. Gordon with Tricare has had the GB. Good luck to you.
   — trcrowell

March 19, 2006
Hey! I had my approval in 3 days from Tricare-I am 5'3 and was 251. It was super easy for me and I would definately get that PCM and go for it!!!!!!! Good luck!
   — Sweet Pea

March 19, 2006
Hi! I also have tricare prime and had such an easy time with them. I had an automobile accident in 2003 and have muscle pains from both neck and back breakings...I was approved ONE day after seeing my surgeon. I need to loose about 130 pounds to meet the met life standards and I now have a surgery date of April 6th. I didnt even start thinking about WLS until the last week in January so, it really seems like everything has gone fast and easy for me. Hope you will have the same experience. Take care now. Jackie L
   — justmejackie

March 19, 2006
Hi I'm at Fort Hood and I was 5' and 260 lbs. I had my surgery in Nov. 17 2005. My approval was quick thru Tricare prime. Only thing I had to pay for was my Nutrien Consult and I got a check back from them the other day. I was told bmi of 35 with a medical problem or a bmi of 40 with no medical problems. As for the tummy tuck a year or longer down the road you must have a medical problem for Tricare to pay for it. Like rashes and stuff like that. Right now most of these surgeries are being done off post as most of the surgeons are in Iraq so you get it done quicker. Good Luck and happy health!!!
   — HubbysBrat

March 28, 2006
make sure they are not trying to qualify you for the lap instead of the open bypass because it will hold you up, that is what happened to me. We then resubmitted and everything went smoothly.
   — Beverly M.