Thrown a curveball- Tricare Prime

Saw the Dr. today.  All went smooth enough.  Have to prove I tried to lose weight.- No problem.  I attended WW from March 2009 until Dec 2009 on the monthly plan.  Then I wondered how I would prove it.  Just spoke to condescending chick at WW who was adamant that they had no record of me for those dates.  Even though I had a subscription number and a cancellation printout in front of me for those dates. Grrrrr.....

I thought I had thrown out my weekly guide for that time.  But lo and behold!  I found it.  I jumped up and down (which is no pretty sight) in joy.  There it was my weekly weight record from March until December.....But wait.  August is missing becuase I had to go to Scotland that month (family stuff)  I didn't think of that.

So now I don't have 6 consecutive months to show Tricare.  I have 5 months with one month missing and then 4 months.   I'm really, really upset.  I'm really ill and feel it.  I have ALL the comorbidities except reflux. 

I will go through the motions of this but I think we all know where this is heading -DENIED because I'm a dutiful daughter.

Now what?  I go back to WW. or something similar.  Sure I'll lose a bit of weight after 6 months, then what?  At first I will be too light becuase Tricare dones't care about your BMI They only care that you are 100 lbs overweight.  I am 105 overweight right now.  Whatever I lose will come  back eventually and I will be sicker than ever.

Suddenly my help around the corner is miles and miles down the road.

Sorry had to vent.

Sorry you are having to jump through extra hoops. I guess not all tricare locations are the same? I didn't have to have a history or anything like that. Spoke to a surgeon and scheduled at the same appt. Are you at an MTF or civilian doc?

civillian, but I could maybe go to a MTF (DC area) or Hampton Roads in a pinch, but I think they have the same requirements regarding weight loss program.  (They may not be quite so strict on the month gap in my 9 month quest)  I'm pretty sure I paid for that month but I just wasn't in the country to attend the meetings.

We'll see.  (I will double check the requirements for MTF)  (They even do the sleeve) 

Yeah, I waited until we PCS'd to an area with an MTF because I wanted a sleeve. In some cases, most I think, the requirements and approval process is completely at the surgeons discretion at MTF's. I agree that you should just ask your PCP for a letter of documentation also.

I had tricare as my insurance...Just have your PCP write a letter or what not and show your 6 "consecutive" months...(the 5 and 4 added together)... All this stuff is just about filling in the boxes and jumping through hoops..

A good PCP will get what you need (TELL them what you need...I told my PCP to write up that I had been doing 6 consectutuve months and what I needed him to write up, and what tests I needed ordered..)

Tricare is a pain in the butt, they make you do a lot of work, but I got through it all in 1 month.

Warmly,
Jackie

 Only having to show 5 to 6 MONTHS?  I had to show years. You might want to go back and clarify that isn't what they are asking. Because I have to show every weigh in I did at my doctors office for the past  5 years. It sucks for extra hoops yes, but they are just making sure you actually tried and aren't just trying to make things easier on yourself (this is what I was told, do not shoot the messenger).

 I had to go through a program for six months.  I did not lose any weight on it.  Losing more weight would have put me too low for surgery. I was not even concerned, because I already knew that diets did not work for me.

You know, I can think of another problem.  I did lose some weight.  I just couldn't keep it off, so I stopped attending.  I lost about 30 lbs in a 9 month period.  Then I stopped and maintained for a while, then it started piling back on.


Well, just have to wait and see.  At least I can make a start on losing some weight in the meantime which should help me feel better.

(The MTF's look at BMI so I can lose some and still qualify)  Tricare (for civillians) require you to be 100lbs overweight, but I weighed in at 216 yesterday and that's what counts.

I don't recall this being a requirement for surgery.  Have you actually heard this from TriCare and not just the MTF?

Personally, I would submit what you have and see how it goes.  The worse thing that is going to happen is you're going to either have to do the six consecutive months, or get a letter from your PCP.  In other words, you'd be no worse off than where you are right now right? 

I'm not referred to an MTF (at the moment)  I'm referred to a civillian bariatric specialist. 

Talking to Tricare often leaves my blood pressure higher than when I started -depending on who picks up the phone at the other end.  I couldn't get anywhere with them the last couple of times I called. -In fact some of them can be really condescending, like it's a job requirement. 

I even asked to be put through (very politely) to the people who do the reviews because the person I spoke to thought I wanted Tricare to pay for weigh****chers!

Course he wouldn't do it.  Just told me to submit and then they would decide.  He seemed a bit clueless.  I wasn't looking for a Yes, just either a maybe or a flat no.  He didn't seem to know anything.

Sooooo, guess I'll just go through the motions and wait and see.  If I'm denied, then I'll see if I can get the referral to and MTF as it seems different there.