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Refeek

Why does Tricare Prime (South Region) make you do a 6 month supervised WL Program?

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Hi there, I'm new to the forum but have lurked and read much to help me weigh options.  I'm currently with Tricare Prime (South Region), it appears my wonderful care manager is no longer at the MTF (clinic) so I told the doctor du jour that I wanted Gastric Bypass.  I've had feet issues for the past ten years, I've been working seriously the last two years at getting the weight off.  Once I start losing weight and incorporate exercise I inevitably sustain a foot injury that sidelines me - I've lost the same 20lbs four times.  I am 56 years old and feel like I'm running of time and that if I continue, my feet will never rebound.   As it is, I'm no longer steady on my feet and can only stand on them a couple of hours a day - I need to get the weight off.  

My BMI on the day I was seen was 37.7. For a comorbidity I have sleep apnea and although not a comorbidity, I'm at the doorstep for diabetes (A1C of 5.9) and not surprisingly so, as everyone in my family currently has it.  

The doctor du jour is not particularly sympathetic.  When I told him what I wanted and why, it told me to that I just needed to eat less.   He wanted to argue with me that my sleep apnea might not be severe enough to qualify.  Reluctantly he said he would put the request in.  It ultimately never even went to Tricare, it was denied in the facility and they came back and told me I needed to be see him for six months straight for as a part of a supervised weight loss program.   (Nearly impossible to get an appointment at my MTF - you're lucky if you can get seen within a month and a half - so I already see this as a set up to fail).

I'm trying to figure out what this means.  Is this 6 month deal part of the process?  Is it a test to see if I can harness my willpower and change my thinking?  Is it an attempt to trip me up so that my weight goes down and will be denied?  

If anyone can give me any insight into how I should behave to get through this successfully and get the approval I need - please chime in.  Has anyone here dropped out of Prime to standard to get the approval they needed?  

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I have tricare prime and am wondering the same thing about this 6 month deal. Is it true or not? I have tricare reps on the phone knowing nothing about it but then the lady that called me about the nutritional class told me that there was a 6 month deal. So what is right and wrong?? wondering if you found anything out???

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Many insurances require the 6 month, medically supervised diet prior as part of qualifying. 

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I know this post is older, but I just went through the process and figured I'd update. It depends on the doctor and what program the MTF runs. In Hawaii at Tripler AMC you had to lose 3-5% of your body weight and go to x amount of monthly meetings, the weight loss could take up to 6 months it just depends on you. As far as basic requirements from Tricare for approval, I can tell you those since I went with a civilian surgeon and not an MTF. You just need 3 months of "doctor monitored dieting", so your initial visit plus 3 more. You have to weigh in at least 1 lb under your starting weight, have a psych eval and see a nutritionist at least once. I had my first consult with my surgeon in November and my surgery was in February. Approval was a breeze. The entire process was a breeze actually. 

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