Military Tri-Care insurance

[VegasGrace 1]

Saw the VA mentioned as I'm 100% and use the VA...they aren't worth the drive! Move is a joke...but makes the dept happy they can SAY they have a program. I went to Mexico and was banded. Too bad the VA won't compensate me now I no longer need the meds for the comorbids I had... I'm saving them a ton of money!

oh well, I'm glad I took the step and got the band on my own.

[Shirley221 0]

Hi.

My name is Shirley and I am having the Lap band on the 6th of November in Victoria Texas with a DR. McDainel and am on Medicare and Tri Care For Life. Tri Care For Life is paying what Medicare does not. I think you have to go to your Dr. first and they have to put in the referal for you. My heart DR. at Bamc put in my referal and in a week I had the approval. Don't let them tell you no. Some of the military bases here in San Antonio were doing them but do not have enough DRs. so they are giving referals. Hope this helps. Good luck Shirley221

[calunda 1]

One would think that tricare would gladly fund or do the lap band procedure since it will cut down on their patient's future medical bills.

[ras141414 0]

What code are they using for getting "fills" I see code 43770 for the actual lap banding but I cant find a code for FILLS.

ANY IDEA

[minpinmom 2]

If you are on Medicare (my husband is), it doesn't matter if Tricare approves it or not, Medicare is primary, will pay for it and Tricare will pick up the rest (on anything).

I contacted Tricare South and it is still showing excluded.

I have also contacted the MTF in San Antonio and surrounding areas, they said I would have to live within the city limits and be over 50 years old. I have written letters to each office trying to get an exception to the rules, but nothing. I even told them I would move there (I have a nephew stationed at Lackland - but nothing)

[minpinmom 2]

I also wanted to RE-post this link. It was posted on another thread and I am now addicted to it. Every morning, it is the first thing I do - check to see if any updates have been made to the Tricare manual.

Tricare Manual

Thanks to whomever posted it originally.

Wendy

[dallman 0]

Minpinmom I posted the manual page. I check it every day. I also send an e-mail to tricare at least once a year. I get tired of getting my hope up and then to have it dashed again and again. But will not quit. My knees are starting to bother me now and will have to make a choice soon as to pay for the lap band or do the gastric thing which is not my first choice.

[minpinmom 2]

I feel for you Dallman, I have been trying to get Lapband for 2 years. They approved me for Gastric Bypass immediately, but haven't budged on Lapband. I keep thinking that it has to be approved soon - it is so hard to wait. I am so scared of the bypass - but I can't wait forever and I cant put my family in debt and pay out of pocket. Keep me updated as to your happenings.

[mglaro 0]

I just spoke with my coordinator again this morning to confirm. She says it has been approved. She has been fighting trying to get this approval for the band for sometime now. She says it may not be public yet which is why tricare is saying it is not covered. She has been to seminar with over 50 ppl connected including Dr. Sparks who sits on the board for tricare. She said it is approved just a matter of time b4 the people at tricare office know the new procedure and give out that information. She assures me it is a done deal as she would not be stupid enough to start spreading it and risk having to do a retraction. She was just lucky enough to be one of the few people in the backdoor on this issue. Just wanted to give out the news but I can understand ppl being skeptic about this issue as it has been a long struggle.

[sweethot143 2]

man, had i waited 1 year it would have been free!

[dallman 0]

A lot of us have been waiting for a long time. I am waiting to see it in writing. But I do appreciate the news. I will post the no pay codes for tricare. So far it says it is still unproven. http://www.tricare.osd.mil./nogovernmentpay/govNoPayList_1Oct07.xls

This is up dated about every 3 months I think. This is another tool along with the manual that will give us something to look at while we wait.

Don

[dallman 0]

I might have put that last post wrong. I will have to see it in writing before I can apply for the band because the nurse won't waste her time until it is in black and white. I figure they will wait until January 1. Don't know why but the military seems to do things that way. Is your rep able to get you approved now? If so what is she using for support for approval? If it is a document? Could you post the web address so the rest of us can get our journey started.

Thanks,

Don

[minpinmom 2]

I have waited so long, I would LOVE for it to be approved Jan 1. I will do cartwheels all over Texas! I will keep checking and please post any updates.

[mglaro 0]

I am meeting her and the doctor for my pulmonary eval tomorrow so I will ask her for more details then and see if i can get some information to help others get their journey started :mad:

[phyllser 3]

My primary insurance is Medicare, 2nd, Tricare for Life. I had my surgery 7/20/07. Got an email from Tricare today that a claim had processed so I went online to look it up. All my surgery related claims have been processed so far except for my 2nd fill. Tricare has paid on everything. But, when I looked up my Medicare claims, they paid on everything except for the hospital bill.... $17K! Tricare picked up a little over $500 of that and the EOB states that my share is somewhere around $2400. So I'm wondering why Medicare rejected my claim since I thought I jumped through all their hoops including using a "Center of Excellence". I read somewhere on another thread that they won't pay if you don't stay overnight. If the claim was rejected because I didn't spend the night... that doesn't make sense, #1, and secondly, the doctor's office knew I was Medicare so why didn't they keep me overnight??? I hate to compalin because I know so many are self-pay, but, I'm going to be pretty ticked if I have to pay because they didn't keep me overnight! Can anyone shed some light on this???

I'm going to appeal it, but, it's very frustrating. And a little frightening because one place on the EOB it says I have to pay $2388 and somewhere else it says $9600+!!