Tricare and the Lap band

[beckamarie 0]

I have been looking into the lap band and decided that because our insurance is such a pain that I would go self pay in Mexico but after researching I think I may try and get approved thru our insurance anyway and if that doesn't work then I'll go self pay. Anyone with Tricare Prime insurance have an easy time getting an approval?

[orrn 0]

:clap2: I will have my interview with my surgeon on 4-16... I have done all I need so far, just gonna ride the time out and see for myself. Referral from pcm, was easy to get. I'll keep you posted.

[beckamarie 0]

Here in Hawaii the dont pay from the lapband so I got a referral off post and am going with the RNY instead.I heard at Walter Reed they DO the lapband.

[rrkeithsgirl 0]

I am in Va Bch and my surgeon's office said that at the Portsmouth Naval hospital they will only pay for the Gastric bypass. In addition, they said that Tricare Standard will only pay for the Gastric bypass. Hope that helps.

[Sissy907 1]

I am in Florida and they (TieCare) doesnt pay for them for Prime or Standard. They do have doctors in the AF and Army that do them, the trick is to find them. I know for certain they do them at Walter Reed as that is where my refferal was sent. You may have to pay your way (or catch a hop -dunno if you can hop the whole way with these kind of medical orders- I havent found out yet) but really paying for a ticket is WAY less than being self pay for the band.... I am up to my neck in this situation right, if you need someone to talk to or bounce ideas off of I am always here!

Alli

[pholdennp 0]

ladies- this has been a helpful conversation i found. i was told consider gastric bypass surgery (not the lap band) after 6 months diet, etc.

So i thought i might look into a self pay since i have no interest in bypass.

but after reading this thread (if i'm reading it right)- i'm lead to believe that they do the lap band at walter reed? do any of you have any info that might help me? I'm very close to WR, but i did not think they did it. thanks!

Pattie

[pholdennp 0]

sorry, i mean i was told they do approve for bypass but not lapband

[TMash 0]

:help: Contact your Congress Person and send them as much research on the Lap Band as you can. Ask them to help get it covered under Tricare. The more request for help they get the more likely they are to talk among themselves. Fat people and the Military vote to! Coverage changes usally appear in the Oct. Tricare Handbooks. At the same time ask Lap Band Company, your Doctor, family and friends to help.

[orrn 0]

I am Tricare Prime and this will be my second attempt! It was a year ago that I tried to go through Tricare. This time I have managed to get in the Biaratrics clinic and have done my sleep study, nutrition will be completed in March, blood work is ordered ....plenty still to do but alot farther than last time! I am in San Antonio Tx.:tongue2: They asked me which one I wanted and I chose LB.

[kerimezz77 0]

My husband is my sponser and we have tricare. Prime covers lapband, also.......I did NOT have to go to walter reed. I got it here in the state we live in. We are tricare south. My whole process started on 11 sept, and ended on oct 8th with an approval. If you have been overweight your entire time your spouse has been in, you already have at least 5 years of weights. Call and ask for a referral to a surgion, pluse also make sure the doc you see is for your decision for WLS.

you will need

5 years of weights

diets you have tried.... IE weight watchers, Atkins, pills and drinks.

psych eval

pulmonogist consult for PFT

possibily EKG

and a clearence letter from your PCM

Good luck!

Keri

p.s do not pay this your self when our insurance covers this.

[YngGram 73]

Several of the people who post here have used both stadard and prime. I am standard and found at military.com the guidelines listed. Do a TriCare search here and tons of posts will show. I did one in Oct. because of the info I was getting from a surgeons office that was tring to get me to pay for something they said TriCare required. I communicated with HealthNet (TriCare North) and found the surgeon to be blowing up my skirt.

[mor6300 0]

I am TRICARE North. Primary Clinic is Woodbridge Family Health Center.

I got my PCM to put in a referral. It was sent to WRAMC.

WRAMC sent me off post to BluePoint Surgical Group http://www.vwlsc.com/

I made an appoint with the surgeon. He did a quick evaluation and met with the insurance processor.

During that appointment Marla Tucker provided me with the list of items required by TRICARE PRIME.

1. Cardiac Clearance

2. Pulmonary Clearance

3. Lab results of TSH level & H-pylori

4. Nutritional eval

5. Psychological eval

6. 6 Month Structured Weight Loss Program

I got all of these appointments done and my packet turned in yesterday. I was told it takes HealthNet 2 – 4 weeks to make a decision.

[El Diablo 1]

I am Tricare Prime Remote (Same as prime but with no local MTF's)

My surgery was approved today not to mention all the stuff that led up to now; the sleep studies, psych eval, blood work, ekg, cpap equipment, etc.

I have been very pleased with Tricare

[connie45331 0]

I have tricare prime and I already saw my family dr. She referred me for the lap band no problems. Tricare approved me for 5 visits. I already been to the seminar and turned in my paper work today. I just got to wait now for an appt. to see the surgeon for my first consultation date!

[Tiffykins 673]

Tricare Prime approved my surgery with a civilian pcm to a civilian surgeon. It was a cake walk, 7 days from consult to approval. . .