Change 66 issued today. Manual

Finally,

Don

I talked to my nurse today and she has sent for pre-approval and thinks all of I need is a doctors letter and a psyc eval. I know for gastric bypass tricare is very easy to get. The 200 percent is if you weigh twice what the insurance standard says you should weigh for your height. I expect to hear something back next week or at least right after the first of the year.

Don

Me too Dallman,

I had to get another referral to the surgeon - Thank God, he is already approved, I meet with him Thursday. I can't wait, I just hope that my psych eval that I did 14 months ago for WLS is still good. It took me forever to get in back then. Tricare contractor - Humana is still not showing the update, please post if anyone hears their computer system has the new release. Does anyone know if they require you to meet with a Nutritionist?

Tricare tells me they havent updated yet...should I call again in hopes of speaking to some one else?

Got my disapproval back from humana. I expected that. I am trying to call and see when they expect to have the change installed. Hope to have it done in the first 3 months of 2008. If anyone has any better wibsites than I have posted before pls let me know. Have a Merry Christmas.

Don

How is it that people whose job it is to know these changes, don't know about this? I have been on the phone and in the office of Tricare and everyone I speak to says they do not approve the Lap-Band. It's frustrating!! Finally I had a gal in the Tricare office tell me to print off whatever information I had and bring it in or fax it. That's what I will do.

I did get my referral to see the surgeon from my PCM...I will update.

I faxed the documentation to the Supervisor at Tricare (Humana), she agreed, said that there is NO doubt it is covered, however until Tricare (Military) Implements it, the call in center can't give you an approval. If you look at the "Publications System Change Transmittal For Tricare Policy Manual", it says the Lap Band is now proven and covered, effective date: Feb 1, 2007, but the Implementation Date states: Upon direction of the Contracting Officer. Maybe we can find out who the "Contracting Officer" is and send him a gazillion Christmas cards asking for him to "direct the change" ha! Ok, maybe not, but hopefully it will get done sooner than later. I have met (yet again) with the surgeon, and they are contacting Tricare to see if they can even figure out what all the requirements will be, of course the Tricare call in center doesn't have LapBand in their system. and around and around we go. I don't care, I am so freakin excited that it is covered, I can wait. Come on guys, we are now on the short stick. I remember my dad being in Korea for a year and I was griping that he got extended for 3 months - I remember him saying, "Come on Wendy, you can stand on your head for 3 months!" All of the wait will be over soon. What a fantastic Christmas gift. Think guys, next year, at this time, we will be posting before and after pictures!

Good luck to all of you with Tri Care! I am so glad to hear they will be covering it! My DH is 100% service connected, so we have ChampVA. They have been doing the band for years. I don't know why they took so long to let Tricare paitents get it. I will keep you all in my thoughts to be lined up for approval.

One thing I did with ChampVA was made a "friend" there. I called one day several times with stupid questions. When I got the right person, you know kind, willing to listen ect. I asked her about helping me get approval through. She helped me get it approved in a matter of less than a week! Sometimes it really is all about who you know. I knew it couldn't hurt any! Good luck to all of you!

That Is How Jacked Up Tricare Is.. You Have To Do Their Job For Them If You Want To Get Surg Approval.. Real Pathtic If You Ask Me. I Am So Glad I Go A Second Ppo With Bcbs...

Now I Dont Have To Deal With Tricare West Anymore

Diane In San Diego

Wendy,

I read that too. Well how in the heck do we get the implementation date?! Can you tell I'm a bit anxious about this? LOL!

I brought the paperwork in to Tricare this morning, they said that yes, it was covered. They didn't say anything else about the implementation date or anything.

I feel like it's too good to be true. Something else will happen and it won't be approved.

:::twiddling thumbs:::

this is so exciting.

I have a seminar on Jan 3rd with "the band doctor".

I so hope I can get the lap band.

My husband is in the army so this is great!

I have contacted humana and talked to their rep and of course they did not know this had been approved. I was told to appeal their denial so my case would be put in file to be pulled as soon as the change is implemented. From what I can gather Humana is the contracting officer for this area. I have sent the appeal and will wait rather impatently for my band.

Don:cry

This is great news. I have been waiting to hear when they approved it. i cant not afford to have it done on my own. What are the requirments to have it done through tricare. I know my BMI is like 47 or 48 and have a family history of pretty much everything.:help: I am just young and dont have 5 years of weight loss trying cause i wasnt old enough to start being documented till 3 years ago. I dont think my body can handle 2 more years of this weight. I am just ready to be able to go run with my husband and start a family the healthy way and not have to worry about all the obese side effects. PLease help......

Also is this approved on Tricare Prime or standard?

You need to make an appointment with your PCM and ask them for a referral to see a bariatric surgeon. That will start you in the right direction. I don't think there is a discretion in whether you have Prime or Standard, so it most likely will not matter.

Get the appointment and that will be your first step. Tricare still requires that referral in order to be seen by a surgeon.

As far as the 5 year history goes, I think you're mistaking that for weight loss attempts--it's a 5 year history of being overweight, not dieting.

Go for it! You've got nothing to lose by trying, and evenually it WILL be approved. Hopefully it will be soon!

I assume that that the PCP has to ensure that the patient meets TRICARE REQUIREMENTS first before the referral is written up.. I would take a copy of the transmital with me to the appointment with the PCP. When I took a copy of my Lap Band Surg procedure that was done in Mexico and had it put in to my medical folder, they didnt have a clue as to what procedure I had done. WHen I asked my PCP about getting referred out to see a DR.in the US again she didnt have a clue as to what I was talking about.. GO IN WITH ALL YOUR GUNS first.. Tricare is new at this and the better you are informed the more they need to be informed.

I just want TRIcare to cover my fills and maintenance when I need it.. PLUS BCBS is my back up now.. SO I know I wont have any problems getting insurance to cover me..

GOOD LUck

DIane in San Diego