Question:
Tricare prime haven't heard of bariatric surgery?
I am so frustrated. I got the go ahead from my pcp to go see a surgean. Well I called Tricare to see who was in the system and they said they never heard of this surgery before. I went to their website and no where is bariatric surgery posted. I'm in Utah and very confused can anyone shed any light on this? Thanks — hillafb U. (posted on October 15, 2001)
October 15, 2001
Tricare Prime has heard of the surgery before, but to my knowledge they
only call it a gastric bypass, or stomach stapeling. You can find it that
way in the handbook. You have to be over 100 pounds over your ideal body
weight with one of I think five specified comorbidities, or be twice your
normal body weight. This is one of the BEST insurances to have because I
paid exactly $12 for my surgery. And now without copays yours should be
free if they approve it! So good luck. Feel free to email me if you have
any questions.
— Virginia N.
October 15, 2001
Yes, the previous poster is correct. I am Tricare Prime, getting mine at
the Naval Hospital. From what I understand we end up paying around $22.
Can't beat that. Do check out the handbook. Keep pressing through, they
will work with you and if you qualify, there are no letters to write, or
appealing. Good luck.
— Cheri M.
October 15, 2001
I to have Tricare Prime and had the RNY on September 7th. So far I have
not paid anything but the for the most part my bill will be 11 dollars for
everyday that I was in the Hospital. I didn't have my surgery done at the
Naval Hospital but instead at UNC.
jenna
— jenna F.
October 15, 2001
Angela: Don't let them tell you they don't cover WLS. Go to the Tricare
office and ask for the Tricare handbook...I think it on page 35...not sure
but it's in there. It lists all the criteria. I live in Avaino, Italy and
was flown from Italy to San Antonio, Tx to have the surgery. I had my
surgery at Wilford Hall Medical Center at Lackland, AFB. I met several
people who came from overseas and other states to have the surgery. Email
me if you'd like and I'll be happy to answer any of your questions. Good
Luck! ~~Ciao~~
— perezrdh
October 16, 2001
It's the terminology......ask about Weight Loss surgery or Gastric
bypass surgery.
— [Anonymous]
October 16, 2001
My PCP put my referral in for a gastric bypass....Tricare Prime then
referred me to a civilian doc, since the Army hospital here can't do it.
The surgeon then put in the "letter of medical necessity" and
Tricare approved the surgery within 3 days! They are really great about
it. In my Tricare Prime handbook it says they do not pay for weight loss
surgery, but this is covered as long as it is medicaly necessary. Hope
this helps some.
— blank first name B.
October 16, 2001
I am scheduled for surgery on the 29th of October at Madigan Army Medical
Center (Seattle). I'm not sure which region you fall under for tricare but
I can personally attest to the fact that they do the surgery!! I am active
duty so I get priority placement for the surgery... yes, I am over 100 lbs
and have 5 co-morbities... and AM active duty. Please don't ask me to
explain how I've been able to stay active duty.... sometimes I can't even
explain it... other than to say I was very sick and the medications I was
on (for the last 5 years) exempted me from the weight program. Anyway...
good luck in your quest. I do know that if you are a dependent your wait
is about a year (maybe longer) at Madigan. I also know that I personally
asked for my referal to Madigan. I have had to pay for my own travel, etc.
and have to take normal leave up until they put me on convalesent leave!
One thing about Dr. Clark (Madigan)... he TRULY believes in the surgery...
and that is extremely helpful!! You may have a "journey" to
travel to get approved but once you actually talk to a WLS doctor you will
feel you are where you belong... they understand and what your asking for
isn't wild to them! Good luck and God bless!
— GallopingAngels
October 16, 2001
Tricare Prime here too and post op 8 weeks. Have your pcp put it into the
pc as gastric bypass consult and they should do that with no problems. I
began my process in April and had my surgery in August. Tricare was great
and no out of pocket expenses, except gas to get there!! Good Luck to
you!!!
— ncgal
December 14, 2001
They actually don't have anyone in the system, but I just got approval for
surgery 1/29/2002 with the Rocky Mountain Physicians, using Tricare Prime
without a hitch. Because they don't have anyone in the "network"
that performs the surgery, they will pay for outside the network. I am an
RN, know this group very well and they are the best! They may also be
listed under associated physicians. They have a very organized packet that
walks you through all the steps. The only drawback as far as I'm concerned
is Tricare requires that the surgery is performed at Cottonwood hospital,
rather than St.Mark's where they have much more experience dealing with
bariatric surgery post-op. Please feel free to e-mail me if you have any
further questions, [email protected] Judy Hardman
— JUDY H.
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