November 7, 201213 yr the dr called tosay and said tricare came back and said they would only pay for 50 percent of the surgery anyone ever hear of this?
November 8, 201213 yr the dr called tosay and said tricare came back and said they would only pay for 50 percent of the surgery anyone ever hear of this? no. i havent. i have had tricare prime for 7 yeas now i have tricare prime and they paid all but 183 dollars if a dr refers you, you meet the qualifications, complete pre ops, dr submits for approval.... then tricare will pay for it by approving or not approving it.
November 8, 201213 yr If I just had Tricare it'd be no prob but since I gave 2 other ins that don't cover it then Tricare won't although I meet all criteria
November 8, 201213 yr Hello, I'm new to this and any information would be gratefully appreciated. I am about to be 52 and have been overweight since my last son was born...21 years ago! I am 5'5" my weight floats between 195-203. While we were stationed in Alaska I asked my PCM for help with the lap band and she laughed at me, said I wouldn't qualify. Yet, I would see younger women, who weighed a little more than me that were going in for gastric bypass. If you have any tips that I might could use to convince my PCM, here in Missouri, to get me a referral that would be great. Thanks ~ Connie ~
November 8, 201213 yr Ya'll please feel free to email me. Any help would be most appreciated bmxmomla@aol.com
November 8, 201213 yr Thats weird!! I had my surgery June of last year and Tricare paid all except 25 dollars! I wouldn't think it mattered even though it's Triwest!
November 10, 201213 yr Hello' date=' I'm new to this and any information would be gratefully appreciated. I am about to be 52 and have been overweight since my last son was born...21 years ago! I am 5'5" my weight floats between 195-203. While we were stationed in Alaska I asked my PCM for help with the lap band and she laughed at me, said I wouldn't qualify. Yet, I would see younger women, who weighed a little more than me that were going in for gastric bypass. If you have any tips that I might could use to convince my PCM, here in Missouri, to get me a referral that would be great. Thanks ~ Connie ~[/quote'] Connie, are you at Whiteman AFB??? Barb
November 10, 201213 yr I had my surgery July 09 and tricare paid 100%. Im in Alaska and my doc is awesome. I'm 5'4" and was 252 lbs and lost 10 before surgery. I didn't qualify at first cause I was 239 lbs. I know it's sad but I gained 13 lbs to qualify. I did have high blood pressure at that time also
November 10, 201213 yr I have Tri Care Prime and they paid 100% of my surgery at Fort Sill, Oklahoma, in January. I am 5'6" and weighed 244, I did however have high blood pressure and was on medication for it, also it was a good year before I was able to have surgery due to all the appointments (sleep study, EKG, nutrition, psychiatrist, lab work) the whole process was completely worth it!
November 11, 201213 yr I have tricare prime europe region. I was banded May 23 of this year. Insurance covered it 100%. My doctor put in a referal and a letter of medical nessity. I had seen a nutrionist once and within two weeks of talking to my doctor about lapband I was approved. I tell you this because alot of people are told they have to fo six month seeing a nutrionist before insurance approves it with tri-care but that it not a requirement. I barely even met bmi requirements the day of wiegh ins infact the day of surgery I was actually under bmi requirements and I still was 100% covered. I did however had several co-morbidity. I had weight induced athma, acid reflux and a couple other things. The first time my doctor put in the referal she did not put in the medical nessity letter and tricare told me they needed that all I had to do was call my doctor and ask that she submit that and as soon as that was submitted I was approved within 5 days. You may want to find out if your doctor submitted that because without that its really hard to get approved with tricare
November 11, 201213 yr I also never had to do a sleepstudy, ekg or any of that other stuff to be aproved
November 11, 201213 yr Is your dr out of network? That would cause a lesser level of benefit to be available.
the dr called tosay and said tricare came back and said they would only pay for 50 percent of the surgery anyone ever hear of this?