Here Are The Requirements For Tricare

[mommakatx2 0]

I *finally* got through to someone today who actually did some research and discovered that it is indeed now a covered benefit. I don't know why I had such a hard time with that.

Here is the policy that will tell you what the requirements are. It's a PDF file.

http://manuals.tricare.osd.mil/index.cfm?fuseaction=TMAManuals.PVCSGetFile&PluginVersion=5&ReferenceManual=TP02&ReferenceChange=66&Type=ASOF&Manual=TP02&FileName=C4S13_2.PDF

Good luck to everyone, and please...if you have already been approved please come back and tell us! I'd really like to know if Tricare is following those requirements to a "T" or if they are going on a case-by-case basis.

[mommakatx2 0]

And here is a link to the Met Life Ideal Weight Chart:

Met life ideal height weight tables references

[Sgt Bob 1]

Thanks Mommakat! I've talked to Tricare 5 or 6 times in the last few days (what a chore!) and I had to tell them about that change. Hey, somebody has to get them up to date! You didn't happen to talk to Barbara S. did you?

Today I talked to a woman who actually knew all about it! Woohoo!

She said all I have to do is have the doctor send a Request for Authorization and once it's approved then I had 3 months to do my psych evals, other evals and get my surgery.

[mommakatx2 0]

Hi Sgt. Bob!

Good luck to you! It seems they are slooooooowly figuring this out. I have been on the phone for the last few days as well, and yesterday was the *first* time someone actually said "wait a minute...let's figure this out". Her name was Regina, and she was in Medical Management.

Please keep us posted on your journey with Tricare, and I will do the same!

[Lilpeach_059 0]

Thanks so much guys!

[armywife4life 0]

hey mommakatx2,

the tri care link doesnt seem to work for me got another one?

[VegasJen 0]

Hello fellow Tricare Patients!

I attended my seminar last night, and the surgeons staff was very encouraging about Tricare. They said they have had Tricare pay for several Lap Band Ops aready. Also, they like to work with Tricare because, as far as insurance companies go, Tricare is pretty straight forward - with no doc supervised diets, etc. They are, however, pretty strict with the requirements for surgery qualification (BMI must be 40+, etc)

For what it's worth, hope that helps! :-)

Jen

[irideaqh 0]

Hello fellow Tricare Patients!

I attended my seminar last night, and the surgeons staff was very encouraging about Tricare. They said they have had Tricare pay for several Lap Band Ops aready. Also, they like to work with Tricare because, as far as insurance companies go, Tricare is pretty straight forward - with no doc supervised diets, etc. They are, however, pretty strict with the requirements for surgery qualification (BMI must be 40+, etc)

For what it's worth, hope that helps! :-)

Jen

Jen,

I think Tricare is pretty straight forward for approval, but they do not base it on BMI. Here are the requirements for approval from the Tricare website.

TRICARE covers gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery) is covered only when the beneficiary meets one of the following conditions:

• Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints
  
• Is 200 percent or more over ideal weight for height and bone structure
  
• Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown)

TRICARE does not cover:

• Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction
  
• Biliopancreatic bypass, gastric bubble or balloon for the treatment of morbid obesity

Tricare uses the Metropolitan Life Weight Chart which you can find if you search on-line for it. I was approved very quickly after my PCM referral and then also after my surgeon's referral for the actual lapband procedure. Now I am just waiting to be banded on March 17.

Good luck to you.

[VegasJen 0]

Thank you Lisa! I think I misunderstood the surgeon. I am going in to the office today to start scheduling appts, and I'm sure It will all become clearer for me. :thumbup:

[srugg1 0]

I just called TriCare today and was first told that they don't cover the Lap Band.. Then she double checked, and said that they do.

My Dr is putting in a referral today. I'm excited but scared.

If you've had the procedure done, did you get it done at a MTF or someone else?

I'm nervous about going through a dr that is going to make me do a 6 month diet (even though I've been on WW for that long)..

[Katies 0]

I have Tri-Care but was referred to MTF, Walter Reed Hospital. I have an appointment with the surgeon on the 11th, I have no idea what they will require of me. Has anybody had Lap Band done at an MTF?

[imabitdizzy 0]

Im working on Tricare right now. I just went to the seminar and I submitted the paperwork. According to the little lapband chart they give out, I am at a 37 BMI. So, I am about 80 pounds overweight, instead of 100. I do have health issues that would be relieved with the surgeries.

[RhiettaP 0]

Working with tri care as well....I just got my referral though through my PCM and won't have my initial *consult* until 18-Jun.....I beleive I'm slight under the 100lbs so I'm going to gain weight and add some weight to get approved.

[mom2boys3 0]

I was very worried about getting denied by Tricare, but it was approved the first time around. Im 5'11 and 246. i have high cholesterol and DDD in my lower spine along with other herniations and such. Dont know if my back issue helped it along, because my bmi is a 34. Hope this helps!

[cmedwards 0]

mom2boys3 do you have tricare or tricare prime? I wasn't aware of 2 visits to the Nurtrionist.