Tricare Prime

[drtldt4e 0]

:help:Anyone have Tricare Prime?? Do they cover this surgery? I am cheduled for the seminar on Aug 14. I have already had the appt with my primary doctor and she supports my decision for the lap band. My psych appt is the 30th of this month. Are there more appts that I can go ahead and get out of the way to speed up the process??

[VegasJen 0]

Hi! I have Tricare Standard, but just went through all the hassle of figuring out what they cover. Tricare does NOT cover lap band at all. It is listed as an "unproven procedure" or something like that. They do cover full-up bypass and vertical banding, which I guess is not done as much these days. I think it is crazy that they wil pay $40,000 for bypass but not $15,000 for lap band. So I was very disappointed to realize that I was on my own to pay not only fo the surgery but for all my fills as well.

Where are you stationed? I'm in Las Vegas, at Nellis AFB.

Good Luck to you!

Jen

[TracyinKS 7]

Tricare as I understand it will NOT cover the band but cover the RNY at 100% makes no sense to me...

[Troy45 0]

I'm a Tricare Prime user and had to go self pay. They'd pay for a RNY but I just didn't want to get hacked on. I figured the self pay ended up costing about the same as a cheap car and the car won't improve the quality or length of my life.

[gingersnap 11]

I was really disappointed that Tricare would not cover. In order to get my surgery I had to pick up additional insurance through my work. But it is still a huge savings as compared to self pay.

Like so many others I'm just not willing to take the risk with RNY and have insurance dictate what surgery I should have to address morbid obesity issues. I wish there was a way to get this changed.

Gingersnap

[drtldt4e 0]

I have decided to have the RNY. Done tons of research on this and talked with lot of others that say they would do it again in a heartbeat. Check out ThinnerTimes: Gastric Bypass Surgery for Morbid Obesity. Lots of the people have had the lapband and are having it removed to have the RNY. Thanks for all your help on the Tricare issue.

[moonlillie 0]

Tricare Now covers LapBand

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)
  

TRICARE does not cover:

• Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction
  
• Biliopancreatic bypass, gastric bubble or balloon for the treatment of morbid obesity
  

Tricare uses the Metropolitan Life Weight Chart which you can find if you search on-line for it