Question:
Anyone who has TRICARE-Prime please contact me and help me through the steps!

Anyone who has TRICARE-Prime please contact me and help me through the steps!    — Vanessa @Nebraska (posted on September 26, 2004)

September 26, 2004
Hey, hon! I have Tricare Prime, and let me tell ya, they may be a pain in the rear information-wise, but they'll get you done. First you have to talk to your PCP regular doctor and request a referral. Make sure you go in armed with information so they know that you're aware of what you're going for. Plus, some doctors (who are just people, after all) have differing opinions about WLS. If you get one that won't help you, see someone ELSE! :) Once they put in your referral, you'll get an appt. for a consult with a surgeon. That should not be difficult unless you get an idiot PCP. Their requirements are pretty much medically standard, BMI of 35-40 with obesity-related health problems, or 40 with or without. The way it worked for me last year, was I had to wait a week or so for the referral to go through and the military hospital's surgery clinic to call ME to make the appt. This and everything else I have to say from here on out should be taken with a grain of salt, though, since things change all the time, and every military hospital or surgeon still has the right to set up their own bariatric program differently. That said, I went in for a consult, where the bariatric nurse/program coordinater asked me all kinds of questions, informed me about the surgery type performed there, and made me aware of the risks. At the end of that appt. I was told if I wanted to go ahead with the process, I'd be put on the waiting list. In the meantime, during my wait, I was required to fulfill certain other requirements that had to be done before I would get "the call" to come in for a final one-on-one consult before surgery and receive my surgery date. THese reqs included an introductory seminar and question/answer session by the surgeon himself and the nutritionist. I also had to have labs drawn to determine if there was anything wrong with me or if I needed supplements of any kind. (Turned out I did-I was low on iron. They put me on an iron supplement and also a Vit. C supplement to boost my immunity while waiting.) I also had to do a one-on-one with the nutritionist and attend a support group meeting. At this point, I called back to get an approximate possible surgery timeframe, worried about my husband's impending deployment. I found out then that they had "lost" my name off their waiting list! This is where I advise you to always be the squeaky wheel! Don't be afraid to bug people. I lost about 4 months this way! Finally I got in for my consult date about 9 months after I started the process. And they said they'd "bumped me up" because of losing my name. At the consult I spoke to the doctor about pretty much everything WLS related, and had pre-op tests ordered. I was to wait then for a phone call with a surgery date, which was usually within a month of completion of the tests. SO I began the pre-op testing round. Most of this is just to make sure you're "safe" for surgery and make them aware of any potential problems. The doctor ordered a chest X-ray (breast cancer, pnuemonia screening.) A slew of labs. An EKG. A pap/exam. A psychologist appt. And a gallbladder ultrasound. (Turned out I had some serious stones, so that puppy was outta there anyway.) And at that point, after jumping through all those flaming hoops, spending countless hours driving to appointments and meetings, losing countless more hours of sleep, having every test under the sun done, and putting about a thousand miles on my car, the two doctors at our military hospital suddenly decided to leave, right as I was supposed to have "the call" any day now! Boy I was steamed about that! We didn't get so much as a "bye!"and I had really come to trust and have faith in these guys. But at least it worked out well for me in the end. I was finally allowed permission to go out into the Prime network and seek my own civilian surgeon. I was able to have my surgery with the wonderful civilian surgeon who had been my initial choice, before I'd found out I HAD to go to a military hospital. So I've done it on both sides. Military and Civvy. The civilian doc worked me in and got me done within about 4 1/2 months. I had to go through the same process, pretty much, that I had for the miitary hospital. After my initial seminar, they submitted my info. to Tricare for approval and received it within about a week, I think. My total bills for surgery were in the area of about 37,000 dollars I think. I ended up paying 40 dollars for a computerized psych test that Tricare wouldn't cover because I'd already done the whole psych screening for the mtf. However, it was required by my surgeon, so I didn't consider that a hardship. I also had to pay I believe 100-150 dollars for a nutrition seminar that Tricare wouldn't pay for the same reason. And the customary $5/day in-hospital fee. So out of about 37,000 I paid around $200. Not too shabby, huh? Sorry for going on so long. I just remember being in exactly the same spot, not knowing where to turn next. They can make it so confusing, but don't give up! If you have any questions or just want to chat sometime, you know how to get hold of me! :) Christie, -225
   — christied

September 27, 2004
try to get champus out if you can. i also went through the military hospital but after being on a waiting list for a year, i asked if i could champus out. make sure you let them know what kind of diets you did, any medical problems due to your weight. make sure you have some kind of paper trail too. documenting your health problems. just remember in order to get the excess skin removed when you do go through the surgery, the military hospital will charge any where from 4,000 up. its considered cosmetic even though you have documented problems with loose skin. just thought i'd let you know about that part too. start saving for that too. take care and good luck.let me know how it goes. i'm 14 months post op. i lost 145lbs.
   — Barbara M.

July 20, 2007
Not an answer but a 'think you' for the info. I'm new at this & going thru the pre-op process. Tricare has been a bit vague as to what they want involving test, diet attemps, etc.--although I know gastric-bypass is covered. Tricare absolutely will not approve Lap-Band--is what I was told. I do not live near a military hospital. According to the responses posted--maybe that will be a good thing.
   — yiayiatoni