I *finally* got through to someone today who actually did some research and discovered that it is indeed now a covered benefit. I don't know why I had such a hard time with that.

Here is the policy that will tell you what the requirements are. It's a PDF file.

http://manuals.tricare.osd.mil/index.cfm?fuseaction=TMAManuals.PVCSGetFile&PluginVersion=5&ReferenceManual=TP02&ReferenceChange=66&Type=ASOF&Manual=TP02&FileName=C4S13_2.PDF

Good luck to everyone, and please...if you have already been approved please come back and tell us! I'd really like to know if Tricare is following those requirements to a "T" or if they are going on a case-by-case basis.

I have tricare prime.

I girls i have tricare standard and I have everything done we are just waiting on approval from them

I am really confused about the process. I went to see my PCM yesterday. First of all, she didn't know anything about the process, I knew more than she did. She said she was referring me to a surgeon. What happens next? is there a possibility that the referral could be denied? I tried to look on triwest.com to see if I could see the status of the referral... and it wasnt there... when i called the PCM office they said it wouldnt show up but that I should expect a call in a week... normal?

I am really confused about the process. I went to see my PCM yesterday. First of all, she didn't know anything about the process, I knew more than she did. She said she was referring me to a surgeon. What happens next? is there a possibility that the referral could be denied? I tried to look on triwest.com to see if I could see the status of the referral... and it wasnt there... when i called the PCM office they said it wouldnt show up but that I should expect a call in a week... normal?

For me (and I think everybody else that didnt/doesnt use MD's on base) it went like this (Tricare Prime):

1. Go see PCM, tell them you are interested in Lapband surgery and/or you need a referral to see "Dr. Lapband-Surgeon." Just make sure the surgeon you pick out accepts Tricare

2. Call "Dr. Lapband-Surgeon" and tell him you want the surgery and find out what you need to do at this point. (Also make sure your referral went through...I cant see why it should be denied)

The rest of the steps went like this for me: The lapband surgeon required seminar, Pulm clearance, nutrition visit, psyc eval, TSH level and letter from PCM saying I was cleared for lapband surgery...letter had to say at minimum my height, weight and BMI. My PCM added a lot of extra including previous failed diets, possible co-morbidities and any other health issues.

He then faxed this to Tricare and I followed everything (status of referrals and whether the actual lapband procedure was approved or denied) on humanamilitary.com. Hope this helps

Edited August 4, 200917 yr by Lilpeach_059
clarity

Thanks lilpeach. I didnt tell my PCM which Dr lapband surgeon i wanted to see... only that i wanted to see a surgeon regarding the lap band. She told me i should receive a call in a week or so from the surgeons office....which seems suspect and too easy... I am worried that im going to receive a call from some tricare person telling me that my referral had not been approved. is that possible? i went to humanamilitary... and called, but they told me i had to use the triwest website.. which i did... but my referral info wasnt in there...

Its probably not on there because they have not completed it yet. I cant see then denying a referral except for wanting to see a surgeon outside the network. I would recommend you choose your own surgeon because that way your have more control.

I was very worried about getting denied by Tricare, but it was approved the first time around. Im 5'11 and 246. i have high cholesterol and DDD in my lower spine along with other herniations and such. Dont know if my back issue helped it along, because my bmi is a 34. Hope this helps!

I am in the same boat. Out of the 5 cholesterol blood tests I failed all 5. I'm not quite 100 lbs. overweight. It's more like 83 pounds overweight. I'm really nervous about Tricare not approving it because of that. My BMI is just about 40. I also have Tricare Standard. Oh, I've also tested having a fatty liver so I'm hoping that helps my approval.

does anyone know i to tell if you are 200% over your ideal body weight??

karen

I am really confused about the Tricare process. I wasn't aware that I needed a referral to see doctor that i had picked out. I already have my consult appt. scheduled and then the other day the insurance lady calls and tells me that i need a referal from my primary physican to be seen there. Do i send my referal to them or Tricare? Can someone plz give me som advice......HELP...Im getting so frustrated.:cursing:

the doc you picked out should get a copy of your referral but its also a good idea to fax or bring in a copy to them. in my case i had to wait for my docs office to get their copy then they called my for an apt! so dont worry just call them again and see if they got anything for you et.

karen

Ok that helps alot... I actually do have a copy for my records. So basically as long as my surgeons office has a copy to submit to the insurance company for approval there shouldn't be a problem correct?

:rolleyes2:Im new here and have gone to my seminar and tomorrow is laparoscopy, blood work etc. Im 35 bmi and have back problems...my question is I have tricare prime so how long is the wait for the approval?

Jade-thats correct. Your doctor faxes the referred request directly to Tricare and you are notified when it gets approved, online and by mail.

Shannon-It depends on what your surgeon requires. My surgeon wanted a lot from me, I had almost a dozen "test" type appointments before they'd even send it to Tricare for approval. However, once it was sent I got my answer from Tricare in just 3 days.

Hey Everyone, Im in CA and new to the chat. Today I had the laparoscopic, ultrasound blood work and EKG done, they gave me the paperwork for the 2 week diet prior to surgery. Question am I approved if I am having this all done. I am 35 bmi and 70 lbs over??? any help would be greatly appreciated. I have tricare prime...

I girls i have tricare standard and I have everything done we are just waiting on approval from them

Hello I am in Jacksonville FL too. Tell me who have you been seeing here in Jax that will do you surgery?