Question:
TriCare Prime Help! I live in San Antonio,Tx and hubby is stationed at Lackland AFB
I have an appointment on August at the obesity center at Wilford Hall. Will they ask for a 6 month supervised diet or how does TriCare work? I am very confused and scared I will get denied!! I really want this to happen !! Any help and info on TriCare prime will be VERY appreciated!! :) — sally_ogin (posted on June 28, 2007)
June 28, 2007
Hi Sally, thanks for writing. I am a retired Military spouse, and even
though I have BCBS now with Tricare prime as a secondary, I was Tricare
prime when I had wls surgery in 04. The rules were different then, so I
don't know what the rules are now, but I can advise you on a few things.
First, call your TriCare region and speak to someone, they will tell you
what the rules are. Get it from the horses mouth. Get a booklet with all
the rules and benefits of Tricare, and use it to your advantage. If they
do ask for 6 months supervision, get started. Even if you get a PCS move
along the way, take your records with you and you won't lose any time in
getting a physician to finish your followup when you move. It is a pain in
the rear, because a military move is a big move, but if you really want
this, it will take some work on your part, both now and after you have
surgery. You have to fight yourself for what you really want, it won't
happen without your own support and diligence. Hope this helps. Take
care. Patricia P.
— Patricia P
June 28, 2007
Hey Sally! Well my husband is also military/Air Force and we are here in
Abilene, Texas. I just recently had Lap-Band surgery, but was self pay. I
know that initially when I was looking into surgery they had referred me to
Wilford hall, but no one ever wanted to return our calls. Needless to say,
I believe that if you are having RNY you should make out just fine. That
seems to be the military's surgery of choice right now and they do not seem
to give anyone gruff about having it done. They covered the Lap-Band up
until Dec. of 2004. I personally got tired of fighting with TriCare about
wanting Lap-Band over RNY and just gave in to financing it. I actually
ended up having my surgery done there in San Antonio with a wonderful
surgeon. TriCare had two ways that you could meet their criteria for
surgery. 1. Be more than 100 pounds over your ideal weight with
comorbidities. 2. Be at least double your ideal weight.
I don't know if this will have helped you or not. If you have more
questions I may be able to help you. It is hard to answer for what they
will do when I am unsure which surgery you want and all of that. You are
at least blessed to be by Wilford Hall in that they perform many different
things that you cannot have done anywhere else in the military. I don't
know how comfortable I personally would have been there, but I am basing
that off of my military hospital experiences previously and they could be
an excellent establishment. You ultimately will have to make that decision
for yourself. You can message me through my page if you would like and I
will get back in touch with you.
— fluphystuph
June 28, 2007
Hi, I have Tricare Prime and just had my surgery on June 5. No, they did
not require a 6 month supervised diet. They only have the requirements that
Karen above posted about 100 lbs. over etc. One person I talked to at
Tricare said they consider lapband too new and will not approve that, only
gastric bypass. I was having RNY so that didn't matter to me. I always log
into humana-military.com and my surgery was approved very quickly! One
morning it was pending and that afternoon it was approved. Any other
questions, just send me a message through my profile. Good luck to you!
— Cindy H.
June 29, 2007
hi i also had rny at savannah ga through tricare. they covered
all but 1200.00 to go to a civ doc because they didnt have one
on base. had to be 100 lbs overweight. or have dieabities, or high blood
pressure. check with your tricare office and they will tell you what you
need to know. each base is different
— karen43
June 29, 2007
We have Tricare Standard (my husband is retired USAF) and my surgery was
approved on first request. Approval took approximately 3 weeks.
I realize Tricare Prime requires a referral so I'm not sure how that will
affect your process. Do you have a PCP that is recommending the procedure?
I was told that Tricare does NOT cover lap band, thus I had the RNY. I was
a bit concerned going in, but I have absolultely no regrets now! I only
wish I haven't waited as long as I did.
Good luck!
— CWinLV
June 29, 2007
Hello all!! OP here! Thank you all for your help! I would like to have the
RNY. I went with my PCM and he supports my decision, said it would be best
for me. He sent the referal in on the 19 of June, but they sent it back to
him because they said they needed more info. He resent it and the next day
I got a call sayingI have an appointment on August 2 at the Obesity center
or clinic there at Wilford Hall. I just wonder what that consult is for...
I will have to call TriCare and see what's up with them. I have a civilian
doctor here that I would love to operate on me and last I hear they have no
bariatric surgeons on staff here at WH, so I'll keep you all posted!
Thanks a lot!!
— sally_ogin
June 30, 2007
The doctor you go to will know, the only thing I know is they do not pay
for Lapband only RNY
— DonnaB.
July 8, 2007
Sally, I'm from SA, GO SPURS!!! I now live in Japan. I had my surg. in Sa.
I had it at UTHSC in SA. There is a military doctor from Wilford Hall, Dr.
Steven Bauers, he works with the doctor,prof. that did my surg. Infact, Dr.
Bauers assisted Dr.Schwesinger in my surg. WONDERFUL!!!!! Many tricare
patients go there,UTHSC of SA to get there surg. done. He is a military
doctor, wonderful with patients.
— stacylong
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