Tri care and Lap band

[Guest Susan Tefft]

Hi Needless to say I'm new and I have a problem. I've researched

and want the Lap band. Tri care Prime has given me authorization

to Wish Centers but they won't go for Lap band. I have found a

number of people same situation (insurance) that have had Lap band

as late as two months ago but not now. Any tricky moves ya"ll?

Sent a question to Linstrom and I know they have been through this

same thing before but got 11 pages of lawyer talk saying you got

to pay so we can write a letter so they can still deny you but we got

your money. Maybe I'm being too critical.

I live in the Texas Hill Country. Surgery will be in San Antonio. Met

Dr. Wright with South Texas Bariatrics. They only do Lap band and

he is in network with Tri care. Really like both doctors and their staff.

Now my "wish" is to get this working.

Thanks for any help

Susan

[i2candoit 0]

I too have Tricare. Which they call Triwest here in the San Diego region.

(My husband is active Military.)

I am going through this process as well. I too have found people with Tricare that were banded, but recently there have been only denials that I have heard about. They will cover Gastric Bypass though in a blink.

I'm expecting my denial in a week or so. Then of course I will appeal it. I haven't decided if I am going to appeal it through my docs with the help of Inamed or Obesitylaw.com I am getting prepared for the fight though.

I have been lurking on these boards 3 times a day for months and have done much research. I get the impression that the majority of people get denied first and win through appeal.

"I'm not giving up" So, my advice to you is: "Pray about it and don't give up."

[Guest Susan Tefft]

Hi cando,

Thank you for the info. Wonder if there is a site for Tri care Lap banders.

Wouldn't be surprised.

I got 11 pages of lawyer eze from obesitylaw.com yesterday. I told them

specificially what the deal is. I expected them to say yes we have had

sucess rectifying this problem or unfortunately we have not been suc-

cessful with this problem in the past. Oh no money before we tell you

anything. They should not be that way cause I was prepared to fork over

the cash. Now I'm wary of them. Have you already contacted them about

this? Did Tri care send you an authorization for general surgery. That

is what my auth says. It doesn't deny me anything yet. I know you only

get three trys and you strike out. So I have just been trying to get

information, One spot somewhere,, said make sure that request says

day surgery. Another said have your surgeon call it by pass and collect

the higher fee. Another said that even if you self pay surgeon if Hospital

is in network they will pay for all the rest. So I asked via email about

hospital. Kevin, manning the email desk said, If Tricare refuses the

procedure they will not pay for the hospital. GZEEEE I just don't know.

What I do know. I will not keep messing with Tricare. I'm only 2 1/2

hours from Del Rio and there is a Dr Jose at Acuna that does Lap band

for $7300.00 US. That doesn't cover after surgery visits. Refills are 50.

He has a good following. Happy campers. That matters to me.

My auth was to Wish for by pass. I'm sure they have a following too.

But you must jump through hoops for months. For 10 weeks you must

work on your goals. Goals being what ever their staff (dietian, phyc,

physial therapist, etc etc think you need help with. At least 8 wks on

the diet you will be on after surgery. If I was good at diets I wouldn't

need them!!! Six tiny Snacks a day. They can pospone your surgery

for ever if they don't think you are ready. I'm too old for that dog and

pony show. They (the doctor) doesn't do many Laps yet he does just

this everydayl He gently pushes toward bypass. Smart move he really

doesn't have to do anything after by pass.

Oh, need to close. I need to get back out in the garden. Rain ran me

in for a few minutes. Thanks again and keep me posted if anything

happens. I have found that TRicare can be pushed. Give them a call.

Susan

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