Thrown a curveball- Tricare Prime

I'm tricare prime, I didn't need any diet proof, any NUT nor psych eval. I went to my PCP on base and he put in a referral to tricare. It was done with all preparation within weeks. Additionally I had all medical tests done on base. The only requirement that was put forth was the doc had to be a Center of excellence.

Good Luck
Petra

I did not have to go Thu all that with tricare, my PCP gave a referral I went to the 4 hr seminar in March, did all my test and on August 18 I had my surgery, What did they do change now? wow.. I have a civillian doc, but did all test at Portsmouth, Naval Hospital plus surgery there.

As I understand it, the MTF's don't require the 6 month WW or equivalent.  If you are sent to a civillian specialist, Tricare requires it.  An MTF like Bethesda or Portsmouth is my back up plan.  I did hear that at one point Bethesda's program was full but Portsmouth's wasn't. 

It'd be funny if I ended up in Portsmouth because we lived in Va Bch up 'till last year.

Thanks Petra,

BTW  I see you had a lap band done.  That was what I was going for at first, but leaning to RNY now.

How was the lap for you?  Were you really hungry the first couple of weeks?  There was a woman who had her's done 10 days ago in the waiting room yesterday and she mentioned she was starving.  I suppose that gets easier over time.

I would not indiscriminately advise anybody to get or not to get the lap band. I was not hungry ten days out of surgery. The WLS is different for everybody. I don't know how much you need or want to loose, nor what kind of eater you are. I would suggest going to the Lap band forum and the RNY board also there is a Failed Band board, in which you will find people who were not happy with the band.  Remember that people who are  with happy with their surgery are less likely to be on this forum


Good Luck
Petra

Ok there it is. you saw a doc on BASE. I had to go through a offpost doc to get transferred to a MTF then when the surgeon decided she was leaving I had to get transferred to an OFFpost surgeon. I have been jumpoig through hoops myself and YES tri-care is changing things in their planning, you might want to go check it out because they could say one thing one day and it be different the next, and they are not the only ones who do it either. SOME Surgeons require things to be done just so they have peace of mind that they did everything right.

Don't know if you mean me, but all my doctor's are civilian.  Hubs is retired and we don't live near a base.  Tricare Prime (North) definately have the six month documented attempted weight loss requirement.They e-mailed me a copy of the policy relating to obesity surgery.  I think different regions have different requirements but I don't know.

The surgeons office say Tricare require all the documentation but all they can do is try.  I think I should postpne my nutritional evaluation at their office because it isn't covered by Tricare and it costs over $500.  And if I am denied, I am going back to PCM to get a referral to MTF.  It's further away but travelable.  I did check Bethesda's requirements and the 6 month thing didn't seem to be there.

I feel better now because I have a back up plan.  I just don't want this to drag out for months and months because I am quite ill with the obesity side-effects.  90% of my fat is in my stomach.  I don't have big arms or legs.  I'm very much an apple shape which is not good for health.  I probably need to do another sleep study because I think my Cpap machine needs adjusting because I don't sleep well either.

No someone else had said their PCM was on base. Yes each region is different and the surgeons themselves can decide to add things just so they know they have done everything.

You also have to remember it all depends on the state you live in.  Many states have laws that require 6 months of nutritional counseling before you can have the surgery.  State laws will always trump any insurance policy contracted with the employer.  Including Tricare.  The federal gov't always allow state laws to mandate when necessary, this includes Tricare.

Personally, for the state of Maryland...there is a law in place requiring the 6 months of nutritional counsleing.  My insurance policy abided by this law.

It must be your state's requirement. I have tricare prime and was referred out to a civilian bariatric surgeon here in GA and I do not have the 6 month diet requirement.

I do have a $250 program fee and a $350 psych fee that isn't covered by tricare (of course the psych they use doesn't accept Tricare) so I will have to come out of pocket for it. But $600 in the scheme of things isn't really that bad.. and I will be trying to get some sort of reimbursement from Tricare after I get approved for the surgery .

Good luck!