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Thread: Tricare: Gastric Bypass & Co-Morbidities?

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    #1

    Tricare: Gastric Bypass & Co-Morbidities?

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    New to this site and I have some questions. I read the info on the Tricare site for gastric bypass, but Im wondering if there are some unspoken co-morbidities or some family histories that they look at and take in to consideration? Like I have a liver disease, acid reflux, and back issues. Also family history of cancers, diabetes, high blood pressure, and stroke. Im 5'2 and have a bmi of 38.4.
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    #2
    Doubtful. Tricare is VERY particular about the gastric bypass or similar surgeries. More times than not they don't pay for any kind of weight loss surgery, regardless of medical/family history. It is considered cosmetic. Unless you can get years of documented proof that the surgery is medically necessary it will be hard to get Tricare to approve it. I do know you have to attempt (documented proof) to lose weight. You have to turn into a doctor what you've done to try to lose weight, and only after unsuccessful after so much time would a doctor even consider going down a path of getting Tricare to approve.

    However, much of what you stated are not reasons for being overweight. I know many with those various symptoms who are not overweight. So you might be hard pressed to get a doctor to say those things in the family are reasons for the obesity.

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    #3
    i have known of some that had it done due to being diabetic. I've also saw some that had thyriod issues. ANd htere are some that their PCMs were able to swing it and they didn't have any health issues. Best thing is to talk to your PCM and tricare.
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    If you can get them to call your reflux GERD, that is a qualifying co-morbidity. How's your blood pressure? You don't actually have to have any qualifying co-morbidity if you're twice your ideal weight, and that "ideal" is determined by calculations your surgeon will make based on your height, weight, and bone structure (also determined by the surgeon- lots of people think they have small bone structure and actually have a large one, and vice versa.) What I would recommend is to get a referral to a surgeon and go to a surgical consult. Any surgeon familiar with tricare will be able to evaluate your condition and tell you if they think they can get Tricare to approve your surgery. It's a difficult process, but the worst they can say is no, so it's totally worth it to give it a shot.

    Good luck! I had a gastric bypass covered by Tricare 2.5 years ago, and I'm happy to help you out any way I can!
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    If you have an extensive medical record for you back it can be a reason to get it. My friend has gastric bypass covered by Tricare because of her back problems but it was well documented for a couple years at least.
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    I know 2 people that got it done at balboa based on weight and history. and the fact they got put on the list. it is a teaching hospital though
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    #7
    If your liver condition is fatty liver disease, that might qualify as a co-morbidity. So would things like hypertension, GERD, diabetes, etc. Definitely talk to a doctor, it's worth a shot.
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    #8
    I had a friend get it done at Madigan. Her BMI was a little under 30, but because she had back issues and borderline high BP they paid for it. I think it depends on the doctor, how they file the paper work, ect...
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    #9
    Wow, I've never heard of anyone with a BMI under 30 having gastric bypass! That surprises me.
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    #10
    Quote Originally Posted by LittleMsSunshine View Post
    Wow, I've never heard of anyone with a BMI under 30 having gastric bypass! That surprises me.
    I know. I think it was an awful idea, but to be fair, she stuck to the program and is doing great.
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