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Thread: Tricare Weight Loss Options

  1. Sarah
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    #1

    Tricare Weight Loss Options

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    I have some questions, wondering if theres anyone out there that can help me. Obviously, I'm going to schedule an appointment with my PCM and see what she tells me, but in the mean times maybe someone on here can help me out.

    My husband and I have been trying to conceive for over a year now with no success. Thats just the minor part, we both will be happy to adopt if conceiving on our own isnt gonna work out. I am very much over weight, between 245-255 for the past year or so, the biggest ive been in my life. Ive been struggling with weight issues all my life. I have poly-cystic ovarian syndrome, i was diagnosed at 16. My question is, will that qualify me for weightloss surgery? I really dont want my stomach stappled, but would they cover or help with lapband or another non permanent surgery?
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    #2
    My friend just had a lap band done. It took her almost a year for tricare to approve it. She had to see a nutritionist for x amount of months and then a specialist for x amount more and even then she had to fight Tricare.

    Correction: she had a gastric bypass not a lap band procedure
    Last edited by SandyKay; 02-20-2011 at 08:34 AM.


  3. I'm Awesome
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    #3
    I don't know if PCOS will qualify you since it's not caused by the weight, but the weight can be caused by it. However, depending on your height and just how overweight/obese you are, you may have justification with that as far as your overall health goes. Do you have any other conditions that could be attributed to weight? Knee issues, asthma etc?

    Tricare DOES cover weight loss surgery, but they aren't always the easiest to work with. Other conditions caused by the weight could make it easier to get them to cover it.
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    PCOS isn't listed officially as a qualifying pre-condition, but the right surgeon can code it correctly on the approval request if they know what they are doing. However, even with a qualifying co-morbidity you must be at least 100 pounds over your ideal weight as determined by your surgeon based on height and bone structure. Best bet will be to start working with your PCM- the worst they can say is no! Feel free to let me know if you have other questions about the approval process. There are several of us here on the forums who have had weight loss surgery through Tricare.
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    #6
    Quote Originally Posted by SandyKay View Post
    My friend just had a lap band done. It took her almost a year for tricare to approve it. She had to see a nutritionist for x amount of months and then a specialist for x amount more and even then she had to fight Tricare.

    Correction: she had a gastric bypass not a lap band procedure
    Quote Originally Posted by Loving View Post
    PCOS isn't listed officially as a qualifying pre-condition, but the right surgeon can code it correctly on the approval request if they know what they are doing. However, even with a qualifying co-morbidity you must be at least 100 pounds over your ideal weight as determined by your surgeon based on height and bone structure. Best bet will be to start working with your PCM- the worst they can say is no! Feel free to let me know if you have other questions about the approval process. There are several of us here on the forums who have had weight loss surgery through Tricare.
    Quote Originally Posted by Caimbrie View Post
    I don't know if PCOS will qualify you since it's not caused by the weight, but the weight can be caused by it. However, depending on your height and just how overweight/obese you are, you may have justification with that as far as your overall health goes. Do you have any other conditions that could be attributed to weight? Knee issues, asthma etc?

    Tricare DOES cover weight loss surgery, but they aren't always the easiest to work with. Other conditions caused by the weight could make it easier to get them to cover it.
    ditto....it does take a year (or more) but as long as your doctor agrees with your theory and codes it right to Tricare they might pick it up. It just depends if your PCM sees it like you. He or she may not. There are some other qualifications as well (other health conditions like diabetes, etc) BMI, etc that they may take into account. I believe with the ten or so other cases i have read via forums or with the two I knew from DH's past commands, they send you to a nutritionist and see if you can't lose it on a eating plan and with exercise on your own. I know one lady did that and she was able to do it on her own with help and lost it that way. She said she really was thankful they sent her to that particular specialist.
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    #7
    My friend didn't have to wait a year, more like 6 months, because she has some back issues. The doc told her though that if she didn't have such an extensive medical record of her back pain she would not have been approved for it by Tricare.
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    #8
    I had lapband surgery 2+ years ago right after tricare added it to the list of surgeries they will do.

    I started the process to have surgery by going to my pcm to be referred. Did that in May 2008. I got the referral. Had my first appt with my WLS doctor at the end of may. I got a list of things i needed to get done for surgery. I didn't start the process of working on that list until the middle or end of june. I had surgery Aug 12th. It wasn't a long process for me. I was 100+lbs overweight and am 5'7 and HAD no other health issues. Infact my WLS dr told me i was as healthy as a someone who weighed 120lbs. I called tricare after my referral was approved and was told once i get the referral my surgery was basically approved. I just needed to do the things my WLS doctor wanted before he does surgery.

    The list of things that i had to get done were:
    2 info classes - started end of June
    1 appt with WLS doctor
    2 psych appts
    1 appt with a nutritionist
    1 appt with a movement specialist
    BAM - had a surgery date end of July

    The best thing you can do is make an appt with your PCM and ask to be referred to a WLS doctor. Maybe find a doctor in your area and attend one of the info classes they offer. You'll have the chance to ask the dr questions and it be FREE.




  9. Sarah
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    #9
    These were all really helpful, thanks all!

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