Military Tri-Care insurance

[dallman 0]

Thank you. Any help would be greatly appreciated.

Don:)

[mglaro 0]

ok just got back from my visits today. rhonda, my coorinator says that dr frost called her himself to inform him of the approval. there is a brand new band out called lapband ap system- 360 omniform technology. it's the widest band available, soft, precurved, individual sections and has a high fill volume (0-14cc). the precurved inflation area evenly distributes pressure for complete coverage of the stomach anatomy. it creates broader area of stomach contact to help ensure secure placement so this causes for less chance of slippage which is what she thinks is the reason why tricare is now approving it. it also has a new unlocking mechanism that facilitates repositioning during surgery for accurate placement. positive lock marker ensures the device is secure. the streamlined design makes insertion through retrogastric tunnel easier. she didn't have any specific information for me to pass on regarding approval, but she said she was going to try and reach dr. frost today for some more information. when she speaks with him she will call me and pass the information on to me.

[dallman 0]

Sounds good. Are you using a civilan doctor? I just want to make sure this is not being done on a base because many are not close to a base and are waiting to have it done elsewhere.

Thanks,

Don

[calunda 1]

You are so right! I really appreciate the free hospital and out patient facilities that the VA has for us 100%ers and the other vets. But face it, they have been known to pull a boner once in awhile.

I am furious that I let one of the nutritionists talk me into going through the lap band (stapling or lap band.) that they are doing in little Rock va? They haven't started the surgery yet either.

[calunda 1]

I do not know if the military does bariatrics yet. I am not even sure if I qualify for tricare. I do not even know if they pay for military wives and husbands to have it at a military post or a va???

[mglaro 0]

I do live near a base -Camp Lejeune, N.C. however, my surgery is being done in Greenville, Dr. Mann. It is being done by civillian not military.

Calundra, I am a military wife and yes they do cover it if you qualify...being a good candidate. You will need to discuss it with your PCM and get him/her to put in a referral for you to have a consultation to be considered fpr bariatric surgery. Right now they may tell you they only cover bypass, but it may not be open to public right now. As soon as I hear from my coordinator the details on the approval for the band, I will post more info.

[dallman 0]

Thank you so much. I hate to wait but should be good at. It has been over two years since I made this decision to get the lap band. I have even had the loan approved once but backed out last month. I just knew sometime or other they had to approve the band if the VA and medicare was approving it.

Don:)

[JAM1012 0]

Have been reading some of the post here and some say they have found MTF's that will do the lap band. How do I find out what ones will do it? I just found out today that Tricare will not cover the surgery. And I am very upset over this as I was led to believe that they would cover it. Any information that anyone can pass on to be I would appreciate.

[JAM1012 0]

what MTF's has your mom found that do lap band surgery? I am new to this and just now getting started with TRicare and the lap band

[phyllser 3]

Have been reading some of the post here and some say they have found MTF's that will do the lap band. How do I find out what ones will do it? I just found out today that Tricare will not cover the surgery. And I am very upset over this as I was led to believe that they would cover it. Any information that anyone can pass on to be I would appreciate.

Who told you that Tricare is not paying? I have Medicare primary, Tricare for Life secondary. I had my surgery in July. Tricare has paid on every one of my claims so far including some I was specifically told by my doctor's office would NOT be covered and one that Medicare rejected. My total out of pocket expense has been $202. I recommend you do some more research because I think someone has given you wrong information.

[JAM1012 0]

Phyl

Thanks for your reply. But I have talked with TriCare and they say they will not pay for the lap band. I guess maybe there are several different types or levels of TriCare. Mine is TriCare Prime. (husband is retired Army). So that may be the reason yours pays and mine won't.

[minpinmom 2]

Please note - when Tricare is secondary to Medicare/Medicaid, it will pay for services that are covered by your primary insurance. It has nothing to do with Tricare approving or denying it - they are secondary. My husband has Medicare/Tricare.

[phyllser 3]

Okay, gals. I guess I'll just chill. You all seem to have it all figured out. But from everything I've read, if Tricare has not already approved LapBand, they are on the verge of approving it. I never assume that the person on the other end of the phone necessarily knows what they are talking about, especially when it comes to government entities. And I've been a military dependent for longer than some of you have been alive. Also, I'm a retired RN with more than 6 years experience working with insurance company as a pre-cert nurse. I've learned you never accept a "no" the first time around. I wouldn't be throwing in the towel and saying, "oh, well, I guess I can't get it paid for". But that's up to you.

[minpinmom 2]

Phyll,

I wasn't saying anything about giving up - please re-read my posts, I have been trying to get Tricare to pay for the Lapband for over 2 years. I just know that there is a HUGE difference when you have a different primary insurance.

We are VERY happy that you have gotten Lapband, I am so jealous and excited for you at the same time, but I also feel the need to point out the fact that your case is different than many of us that are going through this.

I am sorry if my post upset you, but I know I like it when people help me by giving me as much information as possible and I feel that my knowledge, however limited, is helpful in this situation.

I contact Tricare almost weekly, as well as written so many letters to MTFs here in Texas, I think they don't even look at them anymore. I check the updated manual daily (ok, sometimes 2 times a day - I am a bit obsessive). I LOVE to hear any news about Tricare and the Lapband.

Please keep us updated here on the "Tricare" Thread as to your successes, we need to know there is a retired Military wife getting skinny out there!

[mgordon1 0]

Let me understand this, Tricare now approves the lapband????. I am due for to have the lapband surgery in about four weeks. I was so dreading having to pay the deductible and insurance from my job. Please post any information regarding when it will be effective. Thanks