Tricare Prime - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

drtldt4e · 07-21-2007, 08:08 PM

I want to know if there are any tricks to get tricare to approve the GBS? I go to the seminar on the 8th of Aug and will fill out the paperwork. In the meantime, I will have gone for the Psych eval, sleep study, and nuclear stress test that my PCM has ordered. Does Tricare require you to follow a physicians diet before approval? I have tried WW and JC many times. Please give any info that you have. Thanks

Alleusion · 07-21-2007, 08:34 PM

I had at least 6 months of nutritionist visits in my medical record as well as a year of Jenny Criag. I don't know if I would have been approved had I not had the nutritionist appointment, but I had gone to see her about a year or so before talking to my PCP about the surgery.

Good luck, let us know what they say.

moosie · 08-17-2007, 04:57 PM

My mom was approved by Tri Care without the dr.s diet. She was approved really fast too.

KarenInKali · 08-17-2007, 05:25 PM

Do you have co-morbids? It seems Tricare is becoming a little stricter lately. I know of some people who were about 100 pounds overweight with no co's and were approved. I have recently been denied and am working on my appeal as I also get a sleep study scheduled.

Best of luck to you!

fochaux · 12-27-2007, 01:07 AM

the diet can't be required because it is not stated in tricare policy. i found this out after having had to retain a lawyer to secure approval

Raingirl33 · 01-02-2008, 08:31 AM

Quote:

Originally Posted by fochaux

the diet can't be required because it is not stated in tricare policy. i found this out after having had to retain a lawyer to secure approval

I am tricare prime and no supervised diet was required , I did not have any problems at all from first visit to surgery was a little over a month .

mommy_to_two · 01-04-2008, 09:46 AM

I am going through this with TriCare Prime, and I am having to do the supervised diet. I am in my 3rd month. It has been a blessing in disguise for me!

cherbear716 · 01-04-2008, 06:41 PM

I was denied by Tricare today. My BMI is 39 with degenerative disk disease, high blood pressure and high cholesterol. Don't know if it is worth is to argue the decision.

fisher1000 · 01-04-2008, 07:01 PM

Quote:

Originally Posted by cherbear716

Don't know if it is worth is to argue the decision.

FIGHT! FIGHT! FIGHT!

If you don't fight for yourself who's going to? Insurance is a game and you have to keep playing to win at it. This is just a roadblock...you'll get through it--don't give up!

-Mike

cherbear716 · 01-04-2008, 07:40 PM

Is there anyone that knows how to get around Triwest? They said that I was not 100 lbs over. I am only 9 lbs from being 100 lbs over and be qualified for coverage with a 39 BMI. I guess I don't know what my next move should be. I am fairly new to Triwest and haven't used it much. Anyone out there for advice. I'm 5' 198.