Welcome to TRICARE, your Military Health Plan
Tri-care has change its policy
New TRICARE Policy Adds Weight-Loss Options (Article 2) A recent change in TRICARE policy now provides coverage for laparoscopic adjustable gastric banding (Lap-Band® surgery), opening new avenues of treatment for those fighting morbid obesity. This policy change is retroactive to Feb. 1, 2007. If you’ve had Lap-Band surgery since Feb. 1, 2007, and qualify under the new policy guidelines outlined below, you may submit a claim for reimbursement or, if you submitted a claim and it was denied, you may appeal the denial.
Lap-Band surgery is a minimally invasive procedure that can help you shed excess body weight. The Lap-Band shrinks your stomach and restricts how much food you can eat at one time.
You are eligible for Lap-Band surgery if you meet any one of the following conditions:
You are 100 pounds over the ideal weight for height and bone structure and have one of these associated medical conditions:
Diabetes mellitus
Hypertension
Cholecystitis
Narcolepsy
Pickwickian syndrome (or other severe respiratory disease)
Hypothalamic disorder
Severe arthritis of the weight-bearing joints
You are 200 percent or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category.
You have had an intestinal bypass or other surgery for obesity and, because of complications, require a second surgery (a takedown).
For more information about Lap-Band surgery, talk to your doctor about the benefits and risks of the procedure.
Gastric Bypass
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)