Tricare Prime Remote

[Sgt Bob 1]

I called Tricare and the very nice lady who could not give me a definite answer. She told my to have my doctor submit a pre-authorization and see what happens. I could not find a solid answer in the Tricare manual so I did a lot of searching and this is what I came up with.

CHANGE 55

6010.54-M

JANUARY 30, 2007

SUMMARY OF CHANGES (Continued)

CHAPTER 4 (Continued)

5. Section 13.2 (Surgery For Morbid Obesity). 43644, 43842, 43846, and 43848.

No change. New CPT procedure codes were within procedure code range. We

added the following to Exclusions: laparoscopy, gastric restrictive procedure (CPT

procedure codes 43770:cry - 43774) and gastric restrictive procedure (CPT procedure

codes 43886 - 43888) is unproven. Added “for gastric bypass procedures” for

unlisted codes.

6. Section 20.1 (Nervous System). 61000 - 61860, 61863 - 63048, 63055 - 64999, 95961,

95962, 95970 - 95975, 95978, 95979.

Pulmonary ateriovenous malformation (PAVM) was removed from paragraph

III.B. because it did not belong in this chapter. New CPT procedure codes 61630,

61635, 61640 - 61642 added to Exclusions. Deleted CPT procedure codes 64561 and

64580 from paragraph IV.J. because they were the wrong codes for this procedure.

New CPT procedure code range is 61000 - 61626, 61680 - 61860, 61863 - 63048,

63055 - 64999, 95961, 95962, 95970 - 95975, 95978, 95979.

Link to PDF

So, now we know more than they do.

[minpinmom 2]

When I read that I thought it meant that it is Excluded - meaning they don't cover it? Am I wrong?

[Sgt Bob 1]

When I read that I thought it meant that it is Excluded - meaning they don't cover it? Am I wrong?

Unfortunately, you are not wrong. They do not cover it.

[minpinmom 2]

Thats what I thought, I really think that they will follow suit with all the other government insurances and cover it, but who knows when. Thanks for the extra info.

[sweethot143 2]

Thanks for that info. That saves me a trip to Mexico from Germany. I am 30 minutes from Frankfurt in Wiesbaden. Does this price include the nutrition and psych eval? I know Tricare will pay for those. (Trying to save all I can) Does this doctor do financing? I have only $3000 saved now for this. Did you have to do a pre-op diet? I am soooo excited. I want to be banded by Christmas so that next summer I will be rid of the weight. Where do you live?

Thanks for answering all my questions.

Dee

no he doesn't do financing. if you pay in cash the day of surgery he actually took 1k off the price it was 6k. there are no psych evals or nutrition classes or any info for that matter. I learned all I needed to know from this sight. The fills are free, no pre op diet for me. this is how it went. i called his office, they speak great english, po tickler was the ladies name to ask for. booked a consult. went in 2 days after calling, then they weighed me, gave me a booklet on RNY surgery? for what i don't know.

then he talked to me for about 10 minutes, booked surgery for 2 weeks. i filled out a bunch of medical history stuff a whole booklet full of papers.

i didn't get surgery on my original date because my loan didn't finalize yet, i did a home equity line on a home in the states we have so it took a few weeks to fund.

I had surgery at his friends hospital, like a free hospital, and that's dr. matkovich, he speaks no english. And he is who I have been seeing ever since surgery. he does all my fills under fluouro. i go in, they act as if it's a surprise even though i call and book it, he comes out of surgery takes me to the xray room with his nurse does the fill under fluouro, and i'm out in 10 minutes flat. they don't weigh me or anything. he does ask if i have problems ect. gave me his home and cell number, but he doesn't speak english so that's worthless. lol.

I don't regret it at all, there are no luxuries or anything, but i educated myself and emailed back and forth with my original dr. dr. weiner. and he answers promptly most of the time.

he uses the 10cc VG american band. he also does gastric sleeving where they remove part of your stomach. he wanted to do that on me instead, but i decided against it.

they didn't even give me a post op diet. he said liquids for 1 month!!

I didn't do that. i did 2 weeks. I pretty much followed the standard on here.

i am in bitburg, 2 hrs from frankfurt. in the Eifel Region. good luck i think you'll have a good experience. If I can help in anyway, let me know. I am heading out that way in the end of the month for a fill. dr. matkovich is on holiday until the 25th.

[Beach girl 0]

Wright Patterson AFB in Ohio does lapband.

[Meekie 5]

Were you banded there? Do they only accept patients in their region? Can anyone fly there with tricare and receive services? I have tons of questions. Trying not to self pay.

thanks,

[Beach girl 0]

Dr. Dock at Wright Patterson in Dayton Ohio. I do not know if they accept people just coming in for the surgery. I live 10 miles away from the base. Started the process in June and had it done Sept 11. Surgery staff excellent and very friendly.

[Meekie 5]

Did tricare pay for it?

[futurbander2007 24]

Ft. Lewis will start doing the band in October. I am scheduled to be banded at the beginning of November. Dr. Sebesta is the ONLY doctor on Fort Lewis that will be doing the band. I will finish my pathway classes on Oct. 17th and then off for the psych eval, which I will have to pay out of pocket because Dr. Kerr is booked until the end of the year. From my understanding you have to be based at one of the few military bases that perform the procedure. They do not take outside patients. Hope this helps some of you, don't get discouraged more MTF will start banding within the next 2 yrs.

[ras141414 0]

How Did You Get Ahold Of These Codes

[ras141414 0]

DOES ANYONE KNOW IF TRICARE PAYS FOR FILLS, IF YOU DID NOT GET PRIOR APPORVAL TO EVEN GET THE LAP BAND..I AM A SELF PAY..BUT IF I CAN GET TRICARE TO PAY FOR MY FILLS, THEN I WOULD BE A HAPPY CAMPER..

I TRIED TO CALL MY PCP.. AND SHE DIDNT HAVE A CLUE AS TO WHAT I WAS TALKING ABOUT..

I WOULD SURE LIKE TO TALK TO SOMEONE ABOUT IT.

BUT I CANT GET ANYWHERE HERE IN San Diego TO GIVE ME A STRAIGHT ANSWER.

DIANE

:cry

[lisawynita 0]

I heard from the grape vine that as of Jan 1 2008 Lap bands will be covered. Has any one else heard that or have in other info on it?

[ras141414 0]

I heard from the grape vine that as of Jan 1 2008 Lap bands will be covered. Has any one else heard that or have in other info on it?

IF THE GRAPE VINE IS CORRECT THEN WOULD SAVE ME LOTS OF MONEY TAKING OUT A SECOND HMO JUST TO COVER THE BAND I ALREADY HAVE THAT I PAID FOR.

I AM NOT TAKING A CHANCE MISSING FEHB OPEN SEASON AND NOT GETTING A SECOND HMO,, I AM GOING FOR IT AND FINDING ONE THAT COVERS THIS LAP BAND

I WISH YOU LUCK WITH TRICARE

[pjblundell 0]

Please let me know what the outcome for your question. I have Tricare Prime also, and know they cover the GB, but

unsure if LB is covered, as I like you, have heard both they

do and they do not. pamblundell@aol.com