Does anyone have any idea if Tricare Prime will cover the Lap Band procedure? I have heard no way but then I have heard that they do as well. I have made up my mind to do this so if I can have them cover it, it would bea lot better. Also if they dont cover the whole procedure do they cover any of it at all? Any help would be greatly appreciated.

Thanks :help:

Manual

I have been watching for over 2 years and they are still not covering it. This web site will give you all of the changes as they are approved for the tricare manual. All I know is since the VA and Medicare is approving the lapband it is only a matter of time before tricare will.

Don

Thanks Dallman,

I just wish that they would hurry up with it. They will cover GBP but not LB. Thank you for the info:)

I just got the phone call today that Tricare Prime has denied my claim for the LB but that was expected. I picked up Harvard Pilgrim that began July 1 and I now have a surgery date for July 23. I wouldn't hold my breath waiting for Tricare to cover the surgery if you have any other options. There is too much life to live to wait!

Good Luck!

Gingersnap

I too have Tri-care prime. Tri-care does cover the lap band if you can find a Military Treatment Facility that does the procedure. We are stationed at Ft. Lewis Washington, Ft. Lewis only does gastric bypass. The Naval hospital near us does the lap band. I will be banded there. You have to get a referral from general surgery to go to a different treatment center. They will NOT cover the procedure if you try to go to a civilian provider or if you don't use a MTF near you. You biggest problem would be finding a MTF near you (within 50 miles) that performs the procedure.

Please keep us posted. I am in Germany and there is only Landstuhl treatment facility near Ramstein, AFB. They don't do gastric or any wls. Everyone here has to see a civilian for wls. Do you think they will do the LB? I'm going to try even if I am turned down.

Deelynn

Walter Reed in D.C. also does the lap bands as well as Fort Belvoir right out side of Alexandria Virginia. The only problem that I have ran into is that when you move form those areas you will have to pay for the fills your self. Plus you will have to search for a doctor that will take you if you did not have the band done with them. We are at Fort Sill and I can not find a doctor here so I might have to drive to KC to my old fill doctor.

Thanks for the info. I'll look into seeing if I can fly there and have the band and see if they will pay.

Dee

I just called Wilford Hall, the MTF in San Antonio, TX, they DO LapBand, you must live in the San Antonio area (I am in Houston and they said no way) and you have to be over 50 years old.

Just thought I would pass along the info

What kind of discrimination is that? I am soooo frustrated right now. Mexico sounds good.

Please keep us posted. I am in Germany and there is only Landstuhl treatment facility near Ramstein, AFB. They don't do gastric or any wls. Everyone here has to see a civilian for wls. Do you think they will do the LB? I'm going to try even if I am turned down.

Deelynn

I too am military living in germany. I was a self pay and there is a great surgeon in Frankfurt who does all the tricare GBS, he charges 5000euro for the American Lapband and the fills under fluoro are free with no limit.

Now, there are a few drawbacks to know going in. Such as the language barrier, the distance to Frankfurt, we are 2 hours. The lack of pain meds they gave me. And they pretty much didn't give me any info on the surgery or a post op diet or anything. If I hadn't been on this site I would have ruined my band.

Know your stuff. I've been banded 8 months and it's working just fine. slower than I wanted but still going.

Let me know if you need more info.

I just called their general surgery dept and asked if they did LapBand, the lady said yes, and I asked what I needed to do to get an appt, she said you must live IN San Antonio - I said I lived in Houston, but that Wilford Hall was the closest MTF to me, she said it didn't matter, they will only approve if you are local - and she said I didn't "sound" old enough- she said you have to be 50 years old to do it. GO figure.

I also contacted Brooke (Army) in San Antonio, they said they don't do them, but they are about to start - I am going to call back on Monday and see if I can get their requirements and get on their list.

Ft. Hood does not do them and neither does the Naval Base in Corpus Christi. (I did a LOT of calling today)

Hope this helps someone out there.

Thanks for that info. That saves me a trip to Mexico from Germany. I am 30 minutes from Frankfurt in Wiesbaden. Does this price include the nutrition and psych eval? I know Tricare will pay for those. (Trying to save all I can) Does this doctor do financing? I have only $3000 saved now for this. Did you have to do a pre-op diet? I am soooo excited. I want to be banded by Christmas so that next summer I will be rid of the weight. Where do you live?

Thanks for answering all my questions.

Dee

Does anyone have any idea if Tricare Prime will cover the Lap Band procedure? I have heard no way but then I have heard that they do as well. I have made up my mind to do this so if I can have them cover it, it would bea lot better. Also if they dont cover the whole procedure do they cover any of it at all? Any help would be greatly appreciated.

Thanks :help:

They are supposed to, but I hear different stories on fills.

Check out armytimes.com there's a section in there someplace on insurance. I'll try to find it and post the link

I live in Northern CA and they do not cover it in Triwest does not covered it. If anyone else has had better success in this area, please post. They cover the civilian doctors to do RNY, but not lapband. Luckily, my job has the insurance that does it, but it is only at 80%. Anyone else had any luck with having tricare to covering the lapband with a civilian doctor?

I called Tricare and the very nice lady who could not give me a definite answer. She told my to have my doctor submit a pre-authorization and see what happens. I could not find a solid answer in the Tricare manual so I did a lot of searching and this is what I came up with.

CHANGE 55

6010.54-M

JANUARY 30, 2007

SUMMARY OF CHANGES (Continued)

CHAPTER 4 (Continued)

5. Section 13.2 (Surgery For Morbid Obesity). 43644, 43842, 43846, and 43848.

No change. New CPT procedure codes were within procedure code range. We

added the following to Exclusions: laparoscopy, gastric restrictive procedure (CPT

procedure codes 43770:cry - 43774) and gastric restrictive procedure (CPT procedure

codes 43886 - 43888) is unproven. Added “for gastric bypass procedures” for

unlisted codes.

6. Section 20.1 (Nervous System). 61000 - 61860, 61863 - 63048, 63055 - 64999, 95961,

95962, 95970 - 95975, 95978, 95979.

Pulmonary ateriovenous malformation (PAVM) was removed from paragraph

III.B. because it did not belong in this chapter. New CPT procedure codes 61630,

61635, 61640 - 61642 added to Exclusions. Deleted CPT procedure codes 64561 and

64580 from paragraph IV.J. because they were the wrong codes for this procedure.

New CPT procedure code range is 61000 - 61626, 61680 - 61860, 61863 - 63048,

63055 - 64999, 95961, 95962, 95970 - 95975, 95978, 95979.

Link to PDF

So, now we know more than they do.