Tricare now approves lapband

[Lilpeach_059 0]

I spoke with Tricare earlier this week and I was told that Lap band is a Gov't no pay, but the rep told me that if I submitted a referral from the surgeon and got approved that it would be covered.

I also spoke with someone yesterday that told me that since it is a Govt no-pay service that they would not cover it. Then I called right back and spoke with someone else that told me that if I got a referral in and got approved that it would be covered.

So my next step is to meet with the surgeon on 01-14-08 and hopefully things will go smoothly!

But im not too familiar with insurance companies and their policies...I have a question. Tricare rep told me that they only requirements are to be referred by my surgeon. This kinda confuses me...what about the Bmi and evals? :help:

[Jesusislove 26]

Hi, everyone. Thanks for the manual information. I was forced to call the The Office of the Assistant Secretary Department of Defense (Health Affairs); after I was repeatedly told that lap-band prodecure was not a covered beneft by Tricare. I was called back by Health affairs, great people to deal with. I handled it on the phone with Tricare the way they told me to do it. Meanwhile, I was emailed by someone in the contracting office saying they are expecting this policy change to be implemented in 3 weeks. It was a fight but I got us some answers. I was also told that even though the policy change has not been implemented, they still can not deny your claim, big boo boo! They can not deny your claim during the waiting period of the implementation as well. Great people that work there. Thanks for the information about the manual change on here, I finally had somehting to fight with. Thanks guys.

[minpinmom 2]

Thanks for going to bat for us - what a confusing mess.

[dallman 0]

Called Kentucky to the appeal board this morning to let them know that the no pay codes have changed. I asked them when should I recieve my approval letter and if there was anything else I needed to do. Will let you know when I get a reply. If any one gets approved let me know. Also if you get a list of requirements from them pls let me know. This must be a list from tricare not a doctors list.

Thanks,

Don

[zeama 0]

OMG!!!! This is the best news ever! I went in last year and was told all I could get was gastric bypass! I'm calling to get a referral this morning so I can FINALLY get started on this journey!!! :clap2::whoo:

[zeama 0]

So tell me, is this an on-post surgery or off-post? I know that the gastric bypass is done at Ft. Campbell (BACH), so I am wondering if they will start doing the lapband???

[Jesusislove 26]

<p>Hi, good morning, everyone. I was informed that most of Tricare's manuals are outdated, this should be resolved on my Humana Tricare this week. I am assuming this is how it will work. If you live near a military treatment facility that does the Lap-band surgery you may have to go to the military treatment facility. I am Humana Tricare and we do not have a MTF that does the lap-band in Georgia. My referral was put in for one of the doctor's here in town. I will have to attend the seminar on January 18, 2007. I know you must be at least 100lbs overweight with a BMI of 40 (overweight according to the Metropolitan Life chart). If your BMI is not 40 then you must have a least one comorbidity. If you are 200% over your ideal weight, then you automatically qualify. I will check on this again to be sure this is accurate.

[mommakatx2 0]

Thanks for the info Trell! I'm just on the borderline of a 40 BMI. Ugh. I do have arthritis and severe neck/back pain from large breats though. I guess I just won't know anything until I finish the seminar. Mine is on the 15th.

This is such great news, anyway.

[mommakatx2 0]

Jen,

We live near an MTF (Fort Knox), however they do not do the lapband there. I will have to go to Louisville to have it done.

Good luck with everything and keep us posted!

Would be nice to have a Military BG if there isn't one already...

[mgordon1 0]

Hi Everyone - recieved news from Triwest and as of 1/3/08 they have recieved the information that lapband is a covered benefit :-). The service center (reps on the phone) may not have the update as of yet, but the lead told me they have recieved the email from TMA to update their systems and it is now a covered benefit. She told me to have my doctor resubmit the information again (which I did on 1/4/08) and I will let you know what happens. The only problem that I may have is that my doctor is out of network which I have informed them of, however, living in northern california, they aren't many doctors who takes the tricare insurance, that are good and without maintence fees. I rescheduled my surgery until feb08 due to the insurance so that I won't have an high out of pocket expense. Thankfully, I have BCBS PPO as my primary @80% coverage and I want Tricare to cover the deductible.

[mommakatx2 0]

Excellent news! Good luck mgordon1...keep us posted!

[dallman 0]

I have in my possesion a letter of approval for my banding from the tricare appeal board. After over two years of waiting I am on my way. Thanks to everyone for any help that you have given me. :rofl:

Don

[Lilpeach_059 0]

Congrats!! Can you tell us the requirements that Tricare had please? :help:

I have in my possesion a letter of approval for my banding from the tricare appeal board. After over two years of waiting I am on my way. Thanks to everyone for any help that you have given me. :rofl:

Don

[minpinmom 2]

Dallman,

I am so glad you are the first. You have been so helpful to all of us, posting the links and keeping us updated. I couldn't be more happy. Don't forget us Tricare "losers" when your skinny! Keep us updated with your success - I want to know every detail!

Congratulations

[abeaher 0]

minpinmom

I read on one of your posts that you are in Conroe, I am in Magnolia. Tried to email you, but my work comupter blocks EVERYTHING. Where are you in your journey? I see my surgeon for the first time today, fingers crossed for ins. approval.