First off, Hello and welcome. Here are what I hope are answers to some of your questions.
First off, Tricare does not require a 6 month diet. So, the only diet you may have to do is pre op to shrink the liver and that is determined by your surgeon.
Here is how it works.
1. PCM sends referral to Tricare for authorization. Tricare will approve or deny the request. If they approve, they will send you to an in Network provider.
2. Tricare's requirements Gastric Bypass (Surgery for morbid obesity) ? Limited Benefit ? Gastric bypass, gastric stapling, gastroplasty, and vertical banded gastroplasty may be covered when one of the following conditions are met (view Hospitalization Costs):
The patient is 100 pounds over the ideal weight for height and bone structure and has an associated medical condition, such as diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints.
The patient is 200 percent or more of the ideal weight for height and bone structure, regardless of associated medical conditions. (this is by using the metropolitian weight table.)
Laparoscopic adjustable gastric banding is covered, effective February 1, 2007.
The following are not covered:
Biliopancreatic bypass (jejunoileal bypass, Scopinaro procedure) (CPT codes 43645, 43845, 43847 or 43633).
Gastric bubble or balloon
Gastric wrapping/open gastric banding (CPT code 43843)
Unlisted CPT codes 43659 (laparoscopy procedure, stomach); 43999 (open procedure, stomach); and 49329 (laparoscopy procedure, abdomen, peritoneum and omentum).
3. Once you have your consult, there will be some tests that will need to be done. Prior to consult, you can have your PCM do these referrals and get ahead of the game.
Pulmonologist - they may need to do a sleep study
You will need a full work up of labs from A to Z (when I get this done is about 7 tubes of blood) - Also make sure that you get a Hypolori test (this rules out peptic ulcers)
Nutritionist consult. - if you are near a military medical facility, they sometimes have them available, just need referral from PCM. The bad news is that I do not think Tricare will pay for this.
Your PCM will need to write a letter of medical necessity, and you will also need an EKG done and signed off on by the doctor.
The above items is what exactly is requested by Tricare but, the surgeon my have other tests that need to be done.
Oh and one last note, I would get a full exam to document all aches pains and illnesses you may have to help in your quest.