Will Tricare authorize the lap band surgery if I have BMI 40 and no other health problems? Is there a good doctor in the Seattle/Tacoma area that takes TRICARE that's good? Any help would be soooo appreciated. Thanks!

Will Tricare authorize the lap band surgery if I have BMI 40 and no other health problems? Is there a good doctor in the Seattle/Tacoma area that takes TRICARE that's good? Any help would be soooo appreciated. Thanks!

From what I have heard it pretty much depends on day and the person reviewing your case whether or not you get approved, but all the posts I've read for tricare west I have heard of people getting the surgery on that alone, I am tricare North and going to my seminar on monday and then I can make an appointment with the surgeon so if I get any good news I'll let you know. By the way I am in exactly the same boat 40BMi no problems except back pain but they don;t care about that. So I am hoping for a miracle I don;t usully have good luck dealing with tricare

Will Tricare authorize the lap band surgery if I have BMI 40 and no other health problems? Is there a good doctor in the Seattle/Tacoma area that takes TRICARE that's good? Any help would be soooo appreciated. Thanks!

From Tricare's website

Tricare Weight Loss Surgery

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)

So it looks like BMI isn't the issue. It's the number of pounds you are over your ideal weight. They use the MetLife charts and the upper number for medium frame size. So if you are 5'3" - you go by the 5'4" measure (because it says "your height in 1 inch heels")

Here's the chart

Met Life Ideal Weight Chart

So if you're 5'4" in heels, your ideal weight for a medium framed woman is between 124 and 138. Add 100 pounds to the 138 = 238. YOU ALSO must have a comorbid condition on their list : diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints. Now I think this also includes sleep apnea under the narcolepsy category, but not sure.

OR

If you are 200 % above your ideal weight. This would mean the same person at 5'3" (5'4" in heels) would need to weigh above 276. This doesn't require a health condition.

I fall in the first category, and am beginning my process. Hopefully I get approved. Hope this helped.

Michelle

Dr. William D. Neal in Olympia takes Tricare.