Referral & active army insurance question

[LouiseandThelma 8]

Mrzsmitty2015, I have been thinking a lot about our conversation the other day about if Tricare covers the Sleeve or not. If you go back to the place where you found the requirements for WLS covered by Tricare: Right under this section You have proof of one of the following:

• A body mass index greater than or equal to 40 kilograms per meter squared (kg/m2); or
• A body-mass index of 35-39.9 kg/m2 with one clinically significant comorbidity, including but not limited to, cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, Pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy, or pulmonary hypertension

Where it starts the next section:

TRICARE doesn't cover the following services:

• Office visits solely for the treatment of obesity
• Non-surgical procedures treatment of obesity
• Nutrition and diet counseling
• Biliopancreatic bypass (jejunolilea bypass, Scopinaro procedure)
• Gastric bubble or balloon
• SLEEVE GASTRECTOMY
• Gastric wrapping/open gastric banding
• Unlisted procedures

TRICARE Does Cover the following open or laparoscopic bariatric surgical procedures for WLS:

Roux-en-Y gastric-bypass

Vertical banded gastroplasty (This not the sleeve)

Gastroplasty (stomach stapling)

Adjustable gastric banding (i.e. adjustable LAP-BAND

When you find out on Wednesday if you have been approved for WLS please let me know. You said that you live 30 minutes from the base and maybe that is why they are now covering the sleeve. I thought about that too, to be honest our nearest BASE hospital is 500 miles from us. If we have anything major we are Tricare out and have to travel up to Miami for care which is over 150 miles. If Tricare has started covering the sleeve since the last time I called and checked back in September 2014 I would like to know. Then I wouldn't have to drive 1,000 miles roundtrip, sometimes twice a month to meet the requirements for WLS. 150 miles would be a lot easier and cheaper.

When you receive your approval from Tricare this week. The first thing I would ask Which surgery have you approved me for. I hope Tricare has changed their coverage and will cover the sleeve that would be Great! Looking forward to hearing your exciting news this week.