irideaqh

My PCM put in my referral to a bariatric surgeon for "obesity", then the surgeon's office got the authorization from Tricare for the actual lapband surgery. I have a civilian PCM. I don't know if Tricare requires or just prefers a "Center of Excellence" status, but the surgeon my PCM referred me according to Tricare is not "COE" status and Tricare called me to let me know who in my area is "COE" and my referral was changed to that surgeon. The strange thing is that both surgeons are in the same practice. Good luck.

I think approval is very easy as long as you meet Tricare's requirements. Once I got my PCM referral for lapband, I was approved by Tricare very quickly. My only hold up was that the PCM referred me to a doctor that was not a "Center of Excellence" doctor, but once Tricare changed my referral to another doctor I was approved the next day. Good luck.

The medication is for H. Pylori, which is a bacteria that can cause peptic ulcers. It is pretty common w/ estimates of 20% of people under 40 having the bacteria and 50% of people over 60 having it. Most people who have it do not develop ulcers. It is given to people who test positive for H. Pylori as a precaution so we do not develop ulcers after we are banded. I also had to take the Prevpac and had side effects from it, but I just kept telling myself it was something I had to do in order to get banded, just like the pre-op diet that I was not looking forward to. You can stick it out and it will be worth it!!

I am being banded on March 17. I just took a week off from work for "vacation". When coworkers ask me if I am doing anything fun for vacation I just tell them I am just planning on relaxing around the house. No one has questioned the Protein shakes etc. I am having for lunch as part of the pre op diet. I am guessing they just assume I am on a diet.

We have only lived here for about 2 years. My husband is in the Air Force and is stationed at Tinker AFB. We really like it and hope to stay here when he retires. Lisa

Jen, I think Tricare is pretty straight forward for approval, but they do not base it on BMI. Here are the requirements for approval from the Tricare website. TRICARE covers gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery) is covered only when the beneficiary meets one of the following conditions: Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints Is 200 percent or more over ideal weight for height and bone structure Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown) TRICARE does not cover: Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction Biliopancreatic bypass, gastric bubble or balloon for the treatment of morbid obesity Tricare uses the Metropolitan Life Weight Chart which you can find if you search on-line for it. I was approved very quickly after my PCM referral and then also after my surgeon's referral for the actual lapband procedure. Now I am just waiting to be banded on March 17. Good luck to you.

I would suggest you either call Tricare to find out what surgeons they have in your area, or look on their website. Then you can start researching those surgeons and find out information about them. Good luck.

WasA, Thanks for the answer to my question. You have an excellent way of explaining things so they are easy to understand.

Do you mind explaining what the port placement issues are? Thanks.

I'm going to be banded on March 17 also. I am so excited I can hardly wait.

I am going to be banded on March 17 also. I am in Oklahoma and will be having surgery at Norman Regional Hospital with Dr. Ronnie Keith. Good luck to everyone else who is having surgery on the 17th.

Tricare does cover Lapband. Their criteria is 100 lbs over the weight for your height (based on Metropolitan Life Weight charts - you can find it on line if you search for it) with one comorbitity or 200% over weight based on the chart w/ no comorbitity. You have to get a referral from your PCM to a surgeon and then the surgeon gets authorization for the surgery. Once you get the ball rolling Tricare seems to be very quick in approving surgery. Good luck.

My primary care doctor submitted my referral to Tricare South for a consult with a surgeon for lap band. I just got a phone call from a Tricare rep and she said that they wanted to refer me to a surgeon who is affiliated with a "Center of Excellence". Has anyone else had Tricare request this? Luckily the surgeon my doctor requested a referral with is in the same practice as the surgeon that Tricare wants me to see and I had not really had a preference of one over the other. So hopefully all is going well and I am on track to getting the Lap band. I am very happy with how quickly Tricare responded to my doctors referral request. It has only been a couple of days. Lisa in OK

Congratulations. I am one day before you - March 17. Good luck.

TachaBaby505.................Natacha.......................9 January 2008 crystalcml...................Crystal..........................28 January 2008 DxMOM........................Jennifer........................1 Febuary 2008 CynthiaMcC ..................Cynthia......................1 February 2008 Sadie........................Sarah.............................2 February 2008 4jin02.......................Janis...............................4 February 2008 Neenco.......................Dineen..........................4 February 2008 Kittenquite..................Ko................................4 February 2008 slbindc......................Susanne.........................4 February 2008 Babedoe4......................Babe.........................4 February 2008 patticNJ....................Patti................................5 February 2008 petergriffin.................Russ..............................5 February 2008 Big marathoner...............Amy...........................5 February 2008 Michelle9003.................michelle.......................5 February 2008 Beachbum0519.................Alisa........................5 February 2008 girlsmack....................Shannon........................6 February 2008 Lily76............................Lily............................6 February 2008 Peabody......................Amanda........................6 February 2008 JaxBandster..................Karen..........................7 February 2008 EnchantedRuby................Ruby........................7 February 2008 jnbwilds........................Becca........................ 7 February 2008 Shinyhappymommy.........Melissa.....................8 February 2008 TinaBobina...................Tina...........................11 February 2008 LilMissBand-Aid..............Irene.......................11 February 2008 Baby Ruth....................Ruth..........................11 February 2008 MightyQ.......................Quinn........................11 February 2008 Angie4b1g....................Angie........................12 February 2008 aveamora.....................Staci.........................12 February 2008 sharon160....................Sharon.....................12 February 2008 mtmp89......................Mike..........................12 February 2008 GmaDebi...................... Debi ......................... 13 February 2008 Mac the Knife................Mac..........................13 February 2008 travel_anna..................Anna........................13 February 2008 Princess21...................Kimberly....................13 February 2008 Viridescence.................Viri............................14 February 2008 Nikki2001....................Nicole.........................14 February 2008 voxwatt......................Cristina.......................14 February 2008 Glynda.......................Glynda.........................15 February 2008 St Louis Gal.................Pat.............................15 February 2008 HappyOne....................Lesly..........................15 February 2008 saran.........................Sarah..........................15 February 2008 Bluelion........................O...............................18 February 2008 DancingBelly.................Sherry.........................19 February 2008 MinPinMom ...........Wendy..................19 February 2008 AmyJS27.....................Amy........................19 February 2008 Jlobyxmas.....................Megan.........................20 February 2008 TAISMOMMY..................TAMIKA..................20 FEBRUARY 2008 SethsAuntieShel...........Michelle.....................20 February 2008 Rhapsody♥.................Lori........................... 21 February 2008 Rocket City Guy............Tre............................22 February 2008 Peek.........................Kylie (Aust)....................22 February 2008 wantolose155...............Tammy........................25 February 2008 blessedtwice..............Brenda...........................25 February 2008 teegee.......................Tracy...........................25 February 2008 Valvinnek....................Alyssa.........................25 February 2008 Coolcrystal.................Crystal.........................25 February 2008 Gibson........................Christy....................... 25 February 2008 jaunderwood................Joyce..........................26 February 2008 luv2smile.....................Nicole..........................26 February 2008 Amieru.......................Amie............................26 February 2008 Dana-k.......................Dana...........................26 February 2008 hijabigirl1973..........Stephanie.........................26 February 2008 Mel119.......................Melinda...................... 27 February 2008 fireleo.........................Jess..........................29 February 2008 irideaqh......................Lisa............................17 March 2008

Brad, I check for approval status at Humana Military Then choose "online beneficiary services". You have to register to access the site, but then you can check your referral status, see claims that are paid, etc. We are stationed at Tinker AFB. My husband is coming down to Sheppard the first two weeks of March for a class. Any good places to eat down there that he should try? Lisa

Good luck to you Bob. I am sure you will have a date in no time. I have been really impressed with how fast Tricare has been approving people. It may have took them a while to decide to cover the LB procedure, but now that they have they seem to be moving pretty quickly in approving people for the surgery. I am so glad I decided to wait instead of trying to self pay.

Congrats on the surgery date Wendy. Boy that went fast! I had not heard anything about having to be inpatient. The authorization I received in the mail from Tricare actually says outpatient on it. I guess I need to call them and check into it. I would hate to get to the hospital for surgery and then find out that I have to stay overnight. My surgery is March 17. I have to do dietician, psyc apppts and go to a LB support group meeting (required by my surgeon) All that happens next week, but then my husband will be gone for 2 weeks TDY at Sheppard AFB so I needed to wait until he gets back home. Good luck to you and let us know how it goes.

Angela, It might be possible for you to have your surgery before you move. My approval only took a little over a week after the surgeon put in the request for authorization and I think that is longer than usual because Tricare had to make a change due to a problem w/ my PCM referral. My dietician & psyc appts are both next week and I could have surgery sooner, but my husband is going to be TDY for 3 weeks and I wanted to wait until he was going to be back. You should check into it and see if they could get you in before you move.

Angela, I have not had surgery yet, but I have been scheduled for March 17. My PCM referral was just to see the surgeon. The surgeon's office then sent in a referral request to Tricare to get approval for the actual surgery. I also have to meet w/ the dietician, psych, and go to a LB support group meeting before surgery. That is required for my surgeon, not for Tricare. Good luck! Lisa

WOW, you look fabulous!! I am having surgery on March 17 and I can't wait until I can see my collar bone too! Lisa in OK

My surgeon is listed as a "Center of Excellence" surgeon as well as the hospital he is affiliated with. He also performs LB surgery at an outpatient Surgical Center and wanted me to have my surgery there. However, according to the insurance person at his practice, Tricare requires me to have my surgery at the "Center of Excellence" hospital, which is fine with me. I am not sure if that means I will be spending the night in the hospital or not. Guess I need to check into that. Minpinmom - when is your surgery? Lisa in OK

bradkingair - thanks for the congrats. My surgery is scheduled for March 17. I was nervous about asking my PCM about a LB referral. I had already attended a seminar and done lots of research so I was sure that I wanted to have LB and was informed about it. I printed out information about LB and took it with me to my appointment. I also had my surgeon's name, phone number, etc. to give to my PCM so it would be less work for them to do the referral. She asked me some medical history questions (she has only been my Dr for about 2 years) and then said she would refer me. It was pretty easy. Good luck!! Lisa in OK

Wow, I feel really lucky. I was approved on Feb 5 (I had checked on-line), called the surgeon's office, they checked on-line and they made my appointment for Feb 6. I went to my appointment and am scheduled for surgery on March 19. I have Tricare insurance and am not sure how long it will take for me to get the approval letter in the mail, but I am very glad that the surgeon's office did not make me wait for it. Good luck to all of you who are waiting. Lisa in OK

I was just researching to see exactly what "Center of Excellence" was and found the following site if anyone is interested in what requirements it takes to be classified as a "Center of Excellence" or to find a "Center of Excellence" surgeon or hospital in your area. Surgical Review Corporation Lisa in OK