Question:
TriCare Prime and qualifying for GP
My husband will be ARMY active duty as of May 10th; therefore Tricare prime will be my insurance provider since right now i am 5'2 and 250lbs my BMI is around 43, i was hoping someone could tell me about their experiences with TriCare and qualifying for GB. We think we'll be station in Fort Gordon, GA so if anyone has any advice on a PCP i would appreciate it. — Yanelys83 (posted on March 19, 2006)
March 19, 2006
Hi my husband went active in Aug of 2005 I started trying to get approved
for the rny gastric bypass in Oct and I had my surgery in Nov. It took
approx 15 days for tricare to approve me. The only thing they asked for
from was if I had sleep apnea which I did have a very mild case of it so
they approved me. My bmi was 53. Good luck Tricare is pretty easy though.
— ree
March 19, 2006
My experience with Tricare Prime has been nothing but EXCELLENT!!! My PCP
on base, (We are USAF Retired, living in Idaho btw) referred me in December
of 2005, I had my first consultation January 30 2006. I am also,
5'2", weighed 246 at the time, with a BMI of 45.7. My co-morbidities
are hypertension, joint pain, high cholesterol and anxiety, all of which
are being controlled by medication. I also have a family history of
diabetes and I had gestational diabetes with my last pregnancy 10 years ago
where I had to take insulin. My surgeon that I met with considered me an
excellent candidate for WLS so I gave him the go ahead to seek approval
from TriCare. He then ordered a psych eval, (which I had to pay partial
coverage since TriWest only covered 1 hour of the 3 hour test), Ultra sound
and MRI for my abdomen to see if I had gall stones, (covered completely by
Tricare and they did find gall stones), Cardiology exam and stress test,
(completely covered by Tricare with a 12.00 co-pay) and he had me see the
nutritionist he deals with, and that visit was out of pocket since Tricare
did not cover it. All of those evaluations took place in February!! Out
of pocket costs was around 225.00 for nutritionist and partial pay of psych
eval. Since they found gall stones, my surgeon ordered the surgery for the
removal, which took place March 8, completely covered by Tricare. 1 day
after my gall bladder removal, his office staff called to tell me that my
approval for the gastric bypass was recieved by their office and I could
schedule my surgery anywhere between 28 March thru 4 April!!!! I'm due for
surgery 28 March 2006!!! Talk about whirlwind! I'm ecstatic about the care
that Tricare Prime has treated me with! I have also been informed that
they will cover tummy tucks and breast reduction following goal attainment.
How lucky are we to be taken care of like this? I was active duty Air
Force for 7 years and was by my husbands side for 14 of his 20 years of
service. I have no complaints by our healthcare that has been given to us.
I wish you the same luck I have had with Tricare. Please feel free to
email me if you have anymore quesions or would just like to chat about your
experiences! God Bless !
Sandra Sessions
— Sandra S.
March 19, 2006
Hey. Just to let you know that everybody does not have an "easy"
experience...I was denied, then I appealed and decision was overturned and
I now have a date of April 7. In order to be approved with Tricare Prime
you must be at least 100 lbs over your ideal weight with a qualifiing co
morbidity (high blood pressure, sleep apnea, type II diabetes, picwikian
syndrom) OR be 200% (2x) your ideal weight with no co morbidities. Tricare
uses the most recent met life chart to obtain the numbers used to determine
ideal weight. Having said that according to your current weight and height
you should qualify with being 200% over your ideal body weight. As far as
finding a PCP I would assume you will be assigned one once you are
stationed, we usually are. Or you can do a search on this website by
clicking on peers and see who from Ft. Gordon with Tricare has had the GB.
Good luck to you.
— trcrowell
March 19, 2006
Hey! I had my approval in 3 days from Tricare-I am 5'3 and was 251. It was
super easy for me and I would definately get that PCM and go for it!!!!!!!
Good luck!
— Sweet Pea
March 19, 2006
Hi! I also have tricare prime and had such an easy time with them. I had an
automobile accident in 2003 and have muscle pains from both neck and back
breakings...I was approved ONE day after seeing my surgeon. I need to loose
about 130 pounds to meet the met life standards and I now have a surgery
date of April 6th. I didnt even start thinking about WLS until the last
week in January so, it really seems like everything has gone fast and easy
for me. Hope you will have the same experience. Take care now.
Jackie L
— justmejackie
March 19, 2006
Hi I'm at Fort Hood and I was 5' and 260 lbs. I had my surgery in Nov. 17
2005. My approval was quick thru Tricare prime. Only thing I had to pay for
was my Nutrien Consult and I got a check back from them the other day. I
was told bmi of 35 with a medical problem or a bmi of 40 with no medical
problems. As for the tummy tuck a year or longer down the road you must
have a medical problem for Tricare to pay for it. Like rashes and stuff
like that. Right now most of these surgeries are being done off post as
most of the surgeons are in Iraq so you get it done quicker. Good Luck and
happy health!!!
— HubbysBrat
March 28, 2006
make sure they are not trying to qualify you for the lap instead of the
open bypass because it will hold you up, that is what happened to me. We
then resubmitted and everything went smoothly.
— Beverly M.
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