I have seen a few people that said that trice covered the whole lapband surgery, but they had other fees that they had to pay? Does anyone know anything about these other fees and if so does tricare prime cover them.

My husband is active duty and we are covered under Tricare Prime and pretty much everything was covered. The only thing that was not covered was my required appointment with the nutritionist. I was covered for everything else at 100% with no co-pay.

I have a friend that is about to have the surgery with the same doc, but her husband is retired and they are covered with Tricare Prime and she does have co-pays and my doc's office has started charging a program fee of $500 (includes nutritionist, psych eval, Vitamins, and Protein powder) and she said that will be out of pocket for her.

From what I have heard Tricare is just about the best insurance to have for WLS. No hoops to jump through...just BMI of 40 or above or 35 with co-morbidities.

I agree Tricare Prime is pretty easy to work with. My surgeon submitted the request to approve for surgery last Friday, and I was approved yesterday. From day of my first consult appointment with him till yesterday was only 22 days. The hardest part of the whole process has been waiting for the appointment days to roll around.

Dave

There was no copay or anything with Tricare. However, my surgeon does have a $500 "program fee" that's not covered by insurance (they don't even send it to insurance), that they get to keep even if you back out. They tried to bill me for the H. Pylori test, but I refused to pay it because 1) it wasn't part of the written additional fees not covered by insurance and 2) they never even tried to bill tricare for it.

the only thing i had to pay for was 20.00 for the physic dr and for my opti-fast 145.00. everything else was covered.

I had to pay to see the nutritionalist and buy my own food but thats it. They dont cover the nutritionalist because the could be considered "weight loss help that isnt surgery" and they dont cover that. But any visits you have pre surgery once your approved, and then so many visits post surgery are covered because they are billed as part of the surgery itself.

I thought with tricare a nutritionist was required, or does it just vary from doc to doc?

I thought with tricare a nutritionist was required, or does it just vary from doc to doc?

I don't know how Tricare sees it, but my surgeon's team includes a Nutritionist on staff. I've checked the claims section of my Tricare account online, and it shows where the Nutritionist billed Tricare for my consult - and Tricare paid for it. :w00t:

And nobody has mentioned a "program fee" or anything else from the surgeon's office. So maybe they don't have one for certain insurance programs? I do know they "vetted me" before they'd schedule a consult. So maybe they like Tricare for being so easy to work with. ??

At this point the only thing I expect to pay for will be the $25 copay for the overnight stay at the hospital on surgery day, and a $12 copay for office visits.

Dave