Tricare Approval

[AZChick289 1]

I also just got apprved from Tricare and so excited.

One question..Does Tricare cover the fills?

[Jesusislove 26]

Hi, from my understanding from previous threads, yes, they cover the fills. I am going to call them to be for sure.

[LHuston141 0]

New TRICARE Policy Adds Weight-Loss Options (Article 2) A recent change in TRICARE policy now provides coverage for laparoscopic adjustable gastric banding (Lap-Band® surgery), opening new avenues of treatment for those fighting morbid obesity. This policy change is retroactive to Feb. 1, 2007. If you’ve had Lap-Band surgery since Feb. 1, 2007, and qualify under the new policy guidelines outlined below, you may submit a claim for reimbursement or, if you submitted a claim and it was denied, you may appeal the denial.

Lap-Band surgery is a minimally invasive procedure that can help you shed excess body weight. The Lap-Band shrinks your stomach and restricts how much food you can eat at one time.

You are eligible for Lap-Band surgery if you meet any one of the following conditions:

You are 100 pounds over the ideal weight for height and bone structure and have one of these associated medical conditions:

• Diabetes mellitus
  
• Hypertension
  
• Cholecystitis
  
• Narcolepsy
  
• Pickwickian syndrome (or other severe respiratory disease)
  
• Hypothalamic disorder
  
• Severe arthritis of the weight-bearing joints
  

You are 200 percent or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category.

You have had an intestinal bypass or other surgery for obesity and, because of complications, require a second surgery (a takedown).

For more information about Lap-Band surgery, talk to your doctor about the benefits and risks of the procedure.

Edited May 4, 2008 by LHuston141

[Claytaco 0]

You are right, Tri-Care is great. I got to call all of the people that originally wanted the Band but were only covered for the gastric bypass. It was really nice to tell people the great news.

It is impressive how great the coverage is. Things always change in the insurance world, but right now I think it's the best insurance you could have for the band.

Congratulations! I wish you the best.

[Long2BFree 12]

Hi, from my understanding from previous threads, yes, they cover the fills. I am going to call them to be for sure.

I was told by Tricare that they cover the fills 100%.

[Sgt Bob 1]

I was told by Tricare that they cover the fills 100%.

Overall, I have really liked Tricare's service. I have standard and I have much more freedom and options for care than most other plans.

Generally, if I have a health problem, I go to the doctor I need to see (without needing referral) which saves me money, not having to see my PCP just for a referral.

[miissxangela 0]

has anybody been denied by tricare that can tell me how I submit the appeal? I have a letter giving me directions, but what I'm wondering is do I have to submit a letter to them as well as the appeal form? help:eek:I'm pretty bummed out.

[Long2BFree 12]

Overall, I have really liked Tricare's service. I have standard and I have much more freedom and options for care than most other plans.

Generally, if I have a health problem, I go to the doctor I need to see (without needing referral) which saves me money, not having to see my PCP just for a referral.

I have Tricare Standard too and have been very happy with it. I covers everything that I had on an employee plan that I paid for and more. I work on a military installation and they keep trying to get me to swith to getting care at the medical facility but I like the fact that I can stay with the doctor who knows my medical history for the past 15 years. The doctors on base same to change every 2 years which I don't like. Maybe when I get banded and my healt improves I'll go on base.

[Long2BFree 12]

has anybody been denied by tricare that can tell me how I submit the appeal? I have a letter giving me directions, but what I'm wondering is do I have to submit a letter to them as well as the appeal form? help:eek:I'm pretty bummed out.

By looking at your stats I'm guessing you were denied because you didn't meet their requirements. You must be at least 100 lb overweight and have at least one of the other medical conditions. Perhaps you can go to the Tricare office located at the medical facility and they can give you more info.

Good luck!

[bamboolover 0]

I have a headache having gotten off the phone with the surgery center. I was wondering what was left for me to do having not heard from the office. I didn't know that approval was so fast. I had all my testing done beginning of April and now learn that I'm missing one little statement from my pcp about never having needed a pulmonologist. They couldn't call me sooner??? It's over a month later. Thank you for letting me vent. I wish I could get my paperwork and get another office. Though I hear the Dr is great.

[gingersnap 11]

I was denied by Tricare Prime for LapBand surgery May 07. With no coverage and determined to have the Surgery I picked up Harvard Pilgrim through my work. Harvard Pilgrim covered everything but I had the extra cost of the insurance about $150 per month for the last year.

Do any of you think that Tricare would reimburse for the premium cost of Harvard Pilgrim over the last year? I'm dropping HP this month going back to Tricare fulltime.

I'm not even sure about how to go about this!

[Jesusislove 26]

Hi, yes, they will reimburse back to Feb 07.

[BabyGirl2730 3]

If anyone is in WA state please let me know if you are having problems because I have the numbers to call... You should never have to go through submitting any paper work if you are at a military base that does the surgery. If you have to be sent out to a civilian hospital for the surgery I'm not sure then. I had the easiest process ever. Never had to write any letters or anything of that nature like I have heard some people talk about. it took about 3 months for my number to come up for the pathway but once I started the pathway it only took me about 2-3 weeks to get through the pathway. Now I'm just waiting on my appt with the surgeon next week to let him know what surgery I'd like and to schedule my surgery date... If I can help anyone in my area please let me know, I know how it feels to be lost in the beginning!!! :tongue2: