Tricare Prime

Aug 10, 2010

I guess it's their way of reducing their spending, but I don't understand the double standard.  Apparently, to have the surgery done on post (this is according to military hospital websites) you are pretty much approved if your BMI is 40 or above.  To have the surgery done off post, you have to be 100lbs over WITH a co-morbidity or be 200% over your ideal weight based on Metropolitan Life's chart for your "ideal weight" based on your height and body type.  I don't understand why, as my doctor said "your BMI is your BMI".  Fortunately, I found out that an old high school sports injury to my knee has now been a blessing and has qualified me as having a co-morbidity by developing OA.  Regardless, I was considered to be "too healthy" to have the surgery because I didn't have a co-morbidity issue at the time.  You would think that an insurance company would want to avoid all the costs that accompany hypertension, diabetes, etc.  Why would they want to wait until I developed more health issues?  It would seem that by having a "morbidly obese" person have the surgery, it would cost less in the long run.  Not to mention, currently because I am healthy (except for the weight of course) I would be a low risk for surgery, why would you want to wait until I would be a high risk for surgery?  I don't get it....  Anyway, it seems I now qualify and I am looking forward to feeling better, healthier, and living longer.

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