Tricare now approves lapband

[dallman 0]

Change 66 issued today. Manual

Finally,

Don

[minpinmom 2]

Thank you! I am sitting here in tears. I had the worst week ever, I show Min Pins, have bred my first Champion, spent over 2K doing it, and we had to do an emergency csection last night and lost the baby. (there was only one). I have been so sad and depressed, this good news could not have come at a better time.

Thank you so much.

Wendy

[dallman 0]

I am faxing in the new change to my doctor tonight and will let you know what happens. I would imagine it will take a couple of months for everything to get loaded and it show up everywhere. Sorry for your loss.

Don

[TracyinKS 7]

I just posted the link to my surgeons website! Thanks for posting it!

[Yorkie_Luv 0]

This is the best news! :clap2: The insurance lady at my surgeons office told me that they were about to approve it, but she thought it would be after the first of the year. I've already done all the things that Tricare requires for the surgery, now I just gotta wait for the surgeons office to call back with my final approval.....yippee! :whoo: Can someone tell me how to navigate through that manual. The way I read it, it said LapBand effective Feb. 2007...Huh??

[Sgt Bob 1]

From the manual:

V. EFFECTIVE DATES

A. Laparoscopic surgical procedure for gastric bypass and gastric stapling

(gastroplasty), including vertical banded gastroplasty are covered, effective December 2,

2004.

B. Laproscopic adjustable gastric banding is covered, effective February 1, 2007.

- END -

It appears it will indeed be after the 1st of the year.:cry

[minpinmom 2]

I believe the effective date is backdated. A lot of insurance companies do this, once they make a decision, they backdate it according to the date their information was current. Which is good news for anyone who has Tricare that self-paid, they may be able to get some reimbursement. I called Tricare yesterday to make sure, and they said that it isn't a misprint, that it is effective as of LAST February.

Woo Hoo!

[mgordon1 0]

:whoo:HAPPY DAYS ARE HEAR - THANKS FOR THIS UPDATE. :whoo: My lapband is scheduled for 1/16/08 and this is right on time. I phoned my doctors office and they are looking into submitting the paperwork again for me so I will not have an out of pocket deductible. I was not using Tricare because they were not covering it and I did not want to go self pay in case of complications. I was previously approved for the RNY so this should not be a problem. I will update the board with my outcome.

:cry One question to anyone who has the answer, when I called triwest to confirm the change they were still saying the CPT code 43770 (Lapband) was not a covered benefit, however, when I told the rep about change 66, and the change to the tricare manual, she said that they would have to change it. Anyone else had problems confirming the information.

[Yorkie_Luv 0]

Thanks Minpinmom! That was what I wondering. Leave it to Tricare to make the dates confusing. Oh well, so glad they changed it!

[mgordon1 0]

Ok - this one will be quick. My doctors office submitted the change to Tricare and low and behold, they did not have the update yet, imagine my surprise. So I basically walked them through the tricare manual website and showed them the online changes. Needless to say they were surprised and they told me, we did not know about this. They were wondering where did I get the information from. :-) Also, they have change 66 and 67 for the lapband. Change 67 deals with additional wording for the manual.

Note to people using Tricare - print a copy for yourself and refer to it, it appears everything has not been updated yet.

[Sgt Bob 1]

I believe the effective date is backdated. A lot of insurance companies do this, once they make a decision, they backdate it according to the date their information was current. Which is good news for anyone who has Tricare that self-paid, they may be able to get some reimbursement. I called Tricare yesterday to make sure, and they said that it isn't a misprint, that it is effective as of LAST February.

Woo Hoo!

Doh! I guess I need to brush up on my reading skills a bit!:clap2:

Thanks for the translation!

[minpinmom 2]

mgordon1, I have been talking with Tricare (Humana) for 3 days, lol, it is amazing. I actually had to FAX the manual to them, they were completely oblivious. Thankfully, the supervisor that they finally referred me to, is a Lapband wannabe too. I sent her all the information, showed her how to access the information. She contacted Tricare (GOV), and they haven't "issued" the update to Humana, so in their computers it still shows it isn't covered. She is actually checking it everyday and calling me with updates. I just can't believe it is finally covered, I think I am in shock.

[AppleSmith1226 1]

Will Tricare Be Approving The Fills As Well ... I Need To Know Cause My Dh Is Miltary ... And We Have Tricare ... But As Long As I Work My Insurance Comes First.

[mommakatx2 0]

This is the best news! I was just coming here to ask if anyone had any luck with Tricare. The only problem is the requirements, though. My BMI is only 37.7. Sigh. Still more research to do.

[hopefulebndr 0]

What are Tri-care / humana military requirements - it mentions 100 lbs w/co-morbidity or 200%?? What does the 200% mean. For example I'm 245 5'5" that equates to about a 40-41 BMI. Also, what other things are they going to look for - 5 years weight history, prior attempts, etc??? Which co-morbitidy do they count - asthma?? Any info is appreciated. I called TRICARE and they still show not covered, but I do see it referenced in change 66/67.