So... I got my referral, then my approval and then a surgery date. I was going to be the first tricare lapband patient at the hospital.

I went for my pre-op today and a bomb was dropped on me. Apparently the hospital checked with tricare and found out how little they would pay and have decided not to take my insurance. Both the hospital and the doctor accept Tricare... but have decided not to take it for the lapband.

I feel a bit betrayed, by the hospital... but I do understand since apparently Tricare would only pay about $850 over the cost of the lapband. But, I wish they would have figured this out a few months ago before they led me along.

So, I am now shopping for a new surgeon. My surgery was scheduled for June 9... I will be lucky to get in to see a new surgeon by that date.

Does anyone who have Tricare have a copy of their explanation of benefits of what was actually paid for the surgery?

They do them at BAMC at Fort Sam Houston (I think). The only way to make sure is to make the call, but unfortunately I wouldn't know exactly who to call to find the answer.

I had lap band surgery i(self-pay) in Nov and although I have Tricare according to their rules at that time, they only paid for Gastric bypass, not the lapband. you need to go to the tricare website and down load the medical benefits forms to discover what will be paid. I'm glad they approved your surgery which means in the future more people will be able to bill Tricare. I'd also talk to the regional representatives to determine why they pay so little!

Tricare just started paying for Lapband Feb. 1st of 2008 they said they were going to back date it to 2007. I called on January 30th and if you go on line to Tricare and put it lapband it tells you they cover it. That is how I found out about it.

I was banded Nov 2007 and now I find out I can be reimbursed for the self-pay of $13,500. What forms did you fill out for reimbursement and are they on the website? Any money they give me back will be appreciated!

Is your Tricare Prime, Prime Remote, Standard, Extra? That will make a difference.

I am trying to find out what Standard pays...couldn't get it cleared before hubby retired the end of May, and I need to know what I'm going to have to cover. Both the hospital and doctor are contract providers, which I'm told means that they will accept Tricare's payment. But as Standard, I now have a copay and deductable.

My contact lady at Triwest told me that the doctors gets paid about $1000. No wonder no one wants to accept it!

My husband retired 2 years ago. Mine was Tricare Standard. I didn't pay anything but 500 that was for nutritionist and psych but I have a secondary insurance also. I will try to find a bill to see what tricare paid. My total bill was 34877.00 Insurance paid 6049.78 and they wrote off 28827.00. So you are right they don't pay much. I couldn't get it answers when I called Tricare either. I printed out the thing on line that said they paid for it and then just talked to the lady that dealt with the insurance at the doctors office. Whoever does insurance at the doctors office that you go to has the answers you will need. Tricare does have to appove your surgery but once they faxed the paperwork in they had a response in 2 days from Tricare. So it is fast if your doctors office stays on top of it. I just kept calling them until they got me approved. Good luck. I hope I answered all your questions. If you have anymore just email me.

Thanks, Wife...

I really think this is going to be doable...it's just that after so many years of Tricare Prime Remote, and needing only an authorization in place, knowing that I'm going to have some expenses makes me want to pin things down.

I know I will have my deductable. $150. Then, I'm not sure on the hospital if I will have 25% of what Tricare pays, or the $25 outpatient cost. I'm assuming I will have 25% of the doctor's allowed Tricare. My surgeon has an incredible staff, very knowledgable. Just hard to get through to them by phone...they do a lot of these surgeries!

It would be nice to have just one place to go to find all of the answers! My caseworker at Tricare is so good to call me right back, but she wasn't quite sure about some of the charges for the hospital and anesthetist.

You can be sure that if and when I learn anything concrete, I will let folks know what my answers were!

I appreciate your post. Thank you.