[kittykatzmom]

Iam seeing my PCM on Thurs.and will be asking him to refer me for RNY, but 2 yrs ago when I asked him about the Lapband he said that Tricare doesn't cover it and that he has only ever refered 1 other patient for surgery, My worry is that he won't refer me. if not what can I do or where can I go. I NEED this I'm 5'4 and 288lbs and not getting any lighter or younger. I'm 45 yrs old. I want a brighter future.

[mikeesgirl]

I live in WA as well and I have tricare prime too. I was referred earlier this year to an RNY specialist with great support. Tricare doesn't cover the lapband only RNY, but in all honesty the RNY is greater results. I am not sure which base you are at but I went in and was nervous too because I was afraid they would think I wasn't heavy enough or have enough co morbidities and wouldn't refer me. But, I was so surprised because I went in ready to fight and they were wonderful saying it was a great option for me. They just weighed me and did my height to make sure I met BMI requirements and sent in the request. I was denied by tricare the first time because I didn't have any co morbidities like diabetes, hypertension, sleep apnea etc... but later this year I was diagnosed with Sleep Apnea and was resubmitted and I am now approved and should get my official date this week. Good luck and you will be in my prayers. Where in WA are you? I am in Spokane at Fairchild AFB.

[kittykatzmom]

I'm In Shelton outside Olympia but my PCM is at Bangor Naval Hopsital, My Hubby is retired A.F. All I can do Is hope for the best I guess.

[kimtindall]

Welcome and good luck. I was right where you are now...this is the best thing that I could have ever done for ME!

[ilovemykids]

You really shouldn't have a problem getting approved. DH is Active Army. I am seen on post. Tricare Prime South region rules state that if you have co morbidities and BMI of 35 you can qualify. If you have a BMI of 40 and above you qualify without the co morbidities. Of course, you also have the typical requirements of showing unable to sustain weight loss,etc. Good luck to you. I sure your appointment will go great.
Shannon

[Rachael]

Nice to see people from Washington here. I'm from Washington too, but in the north-of-Seattle area.

I'm not military. I do, however, work for the state. Next year they will cover lap band, but ONLY if you are 18, 19 or 20. LOL. I'm well over twice 20, but I'm glad to be going for the RNY. I can't "stomach" the lap band

Okay, sorry.

I'm really worried that my primary care physician won't help me with it either. She knows all my ups and downs, but it seems their office has one of those really holistic/natural-type approaches and I just have this fear that they don't go for it. I'm really hoping I'm so wrong. I'm seeing her Friday.

Best of luck to you, and good to see you!

[MsVickie]

Hi there. I have Tricare myself. They dont pay for the band. If your PCM wont refer you then the only thing you can do is ask for a new PCM. They have to refer you which I know you already know. I will give you a heads up on what they want and require.

You have to have a BMI of atleast 40 along with comorbities.
Such as

High Blood Pressure
Diabetes
Arthritis in one or more weight bearing joints
Sleep Apena
There are a couple more that slip my mind
Or be 200 pounds overweight.

They require that you submit Drs notes showing you have been on medically supervised diet for atleast 6 months at some point.

You have been obese for the last 5 years.
You will have to write a letter stating what diets you have tried over the last 5 years and the outcomes.

They will ask for a EGD. That is the little lite they run down your throat while your sleeping t check out the stomach to make sure they can do the surgery.

They have you tested for H-Pylori to make sure you dont have a ulcer.

Once they get all this they send all your records in and with this insurance company they will have your anwswer within 36 hours. There fast.

There are alot of us that have Tricare that have had this done. I only know of one so far that was denied. Good luck sweetie just get your ducks in a row and go for it !

[kittykatzmom]

YEA!!!!!!! I got my referral and I had a case manger call me to set up an appt. with her on Tues. What does a case manager do? I'm excited to start this JOURNEY to a new me......... ~ Cindy ~

[bren]

I too had tricare prime..if you PCM won't refer you request another PCM its your right to have another doctor if you don't agree with yours. I actually had my surgery at a civillian hospital which was great because the Army hospital here doesn't do the surgery.. Good Luck