I am considering a lap band procedure, and was wondering if anyone has tri care insurance and if so how hard was it to get approved? I called and discussed it with them, and they said it was all in how the doctor coded it. Any input? Thanks

It was pretty easy and relatively fast. All my info is in my sig.

Mine was pretty easy as well....the biggest hold up was getting the psych eval and nutritionist appointments scheduled. Good luck!

When I called Tricare customer service I talked to a really nice lady named Alisha. She laid it all out for me. Tricare Standard does not cover nutrition/psych counseling and you will be responsible for 15 to 20 percent of the surgery. That is not what I wanted to hear.

She went on to tell me that if I enrolled in Tricare Prime, everything is paid for. The surgery and the fills after surgery. It does not cost anything to upgrade. All you have to do is go down to the on base clinic and get a Prime application and a PCM change form. Fill it out and turn it back in.

I just turned mine in yesterday to upgrade to Prime. It will take effect on September 1st. Im calling tomorrow to make my first doctors appointment in almost 4 years. YIKES!

Got approval after my primary insurance declined....it was easy...but you should know that changing to Tricare Prime does have a cost factor if you are in the "Retiree" group (annual enrollment fee for you and/or spouse/family). If you live near a military installation, like I do, they will normally require you to have all your medical care on post----which isn't really feasible because of the number of active duty/family members, etc. that have priority. I found this out the hard way when I was enrolled in Tricare Prime. Remember, cost shares/deductibles, etc. are different if you are not active duty or the spouse of an active duty soldier. Do call the Tricare phone number, those people are fantastic!!! They will stay on the line and help you until you decide that you don't want to talk any longer. Good Luck.

I have tricare prime and am considering lap band too. It looks very easy to get approved but my question is- they use the Met Life tables to determine if you are heavy enough to have the surgery. I'm currently at about 258 but my "zone" in the Met Life table says 163-140ish (i dont remember the lower number). I'm not 100 lbs over the 163. Will I have to gain weight to get it approved? Sounds ridiculous! Atleast its only five pounds.