Jesusislove

Hi, look on your insurance website and make sure it is an exclusion, sometimes insurance companies do not want to pay for the procedure. I do believe Mercy hospital/insurance is under the Catholic health initiative, and the organization does not believe in surgeries of this kind. I used to work for them in the corporate offices for Centura health.

Hi, I am tricare prime, I had not seen my bariatric doctor. They got the procedure approval before the first visit. I am approved for the visits and the lap-band procedure. My surgery is in April. Tricare does not go by BMI at all.

I have joint pain in the knee and recent HBP. If you are double your ideal weight 200% with tricare, you will need no co-morbidities. Only those who are 100lbs overweight will need 1-2 co-morbidities.

Hi, I was on meds 10 years ago HBP, came off, and my doctor put me back on them about a month ago. Did your doctor put this down as a co-morbidity, if so I would ask him for the prescription.

I am using Peachtree Surgical Associates, and they are tricare participating providers and they are a center of excellence. You emailed me about what I had to do, well I had to have a pulmonary clearance, a cardiology clearance including an EKG, A PCM letter of necessity. Nutrition eval and psych eval, tricare does not require neither eval, but the bariatric doctor might. I did all of this before seeing the doctor, this is what their center requires. From my understanding, you can see an out of state doctor as long as it is not too far away.

Hi, tricare does not require a 6-month plan; however, I worked out anyway and my knee went out. I had to get physical therapy on my knee which proved that the joint pain I was having will hinder me from working out like I should. Joint pain was one of my co-morbs.

Have no fear, the Lord is the light of your salvation, whom or what shall you fear. God is with you and you have done well. Fear nothing. I rejoice with you on your weight loss.

Hi, so do they pay for fills and what is the code?

Hi, I am here in Atlanta Georgia, my Lap-band was just approved today by humana tricare south, we are prime. You need at least 2 co-mordbitites and 100lbs over, mine were HBP and Joint Pain. I am approved. I weigh 260, and I am 5' 9", do not give up. If you are 200% overweight, you need no co-morbs. My referral was put in Thursday approved Monday. I barely made it at 260 to be approved, 249 was my Metropolitan Life chart number. Anymore questions just reply.

Tricare does cover lapband, it is a fact, I called the head office and as of Jan 25, 2008 all systems should be updated, prime and all others.

Minpinmom, have you lost more weight? When you checked your referral online did it say pending at first, and then approved? How long did it take for you to see approved.

Hi, Randi, How much do to the fills cost? If tricare covers fills, they should also cover the fills you have paid for as well. Retroactive for insurance companies means that it will go back and cover what you should not have had to pay from the start. From working in the insurance field, they may cover only what you have paid up until now or up until December. They may request that you go to a MTF, starting now. The question is now, do they cover the fills? I have not found that out yet, but will call next week, I want to make sure everything is updated first, they sound like they can not look up anything unless the computer tells them.

Lapband will be officially updated January 25, 2008 I was told by Humana Tricare that all systems should be updated today in the system for the lap-band procedure, so you should not hear from a Tricare rep that they do not see where its covered. I already had my visits authorized to see my doctor before today, approx. a week ago. You must be 100lbs overweight with comorbidities according to the metropolitan life chart. If you fall 100lbs overweight on the chart you're good. If you should weigh 135lbs and you weight 270 or more, you automatically qualify, that is what 200% means, basically you must be double your weight. BMI has no bearing with tricare only weight and height for you bone structure. Weight and bone structure is based on the Metropolitan life charts. You will eventually need clearances from various specialty doctors and your PCM, nutrition eval, and pschy eval, after your packet is accepted by your bariatric doctor. Last edited by trell : Today at 09:48 AM.

I was told by Humana Tricare that all systems should be updated today in the system. I already have my visits authorized to see my doctor before today, a week ago. You must be 100lbs overweight with comorbidities according to the metropolitan life chart. If you fall 100lbs overweight on the chart you're good. If you should weigh 135lbs and you weight 270 or more, you automatically qualify, that is what 200% means. BMI has no bearing with tricare only weight and height for you bone structure. Weight and bone structure is based on the Metropolitan life charts. You will need clearances from you cardiologist, your doctor, nutrition eval, and pschy eval, after your packet is accepted by your bariatric doctor.

This is wonderful news dallman, they are finally doing their job. Let us know the what they required of you. Congrats and thanks for all your information and input on this site.

<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.

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.

Hi, this is awesome news. I checked this forum to see if it had been approved because Tricare tried to call me out of the blue. I had a referral that had been cancelled, they were calling me, so I might be one of the first approvals.