Tricare Prime and Lap Band

[connie45331 0]

Hello,

I am very intersted in the lap band. I went to my doctor to talk about it with her and she approved me and she is now doing the referrel list to tri care. My question is...How hard is it to get the lap band through tricare prime? Thanks! My weight is 205 and height is 4'11. My ideal weight that I should be at for my height is 115lbs.

[PardoBird 0]

I have tricare and it was a pretty easy process for me. Be carefull though they have strict requirements. here is what they require.

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)

Other then that I LOVED getting banded with my insurance ...its 100 percent covered :tongue2:

[JamieNP 20]

Tricare uses the Metlife ht/wt chart and uses medium frame. You must fall in this range. If you are under it by any amount you will get denied (been there!). You need a psy eval, lab work, gall bladder scan, EGD, EKG and go to a nutrition class. Your PCM has to send the referral to Tricare and you will probably be approved for the Surgeon's visit. Then the surgeon will submit the request for surgery. If you get denied, don't be discouraged...there are several of us that got denied the first time and appealed and got an approval. Hope that helps!

[mljalways 1]

I have tricare prime and all I needed was a Pshyc eval and nutrition visit

[help1977 0]

Hi I have Tricare Prime and this is what they wanted from me A referral from my PCM and a Pshyc eval and nutrition visit and whatever test you surgeon orders. My approval for surgery came back in 2 days. I got got my date May 19. Also call Tricare if you have any questions they really are easy to talk to and if they don't know the answer they will find someone who does. I feel like I was alway calling them. I was told Tricare and Tricare Prime do not do everything the same. But I don't know for sure. Good Luck

[dl2418 0]

I am Tricare Prime and am going through the process at the moment. My biggest hurdle was getting my PCM to get the prior authorization for my psych eval. Seriously! Once they finally got to it, it took less than 48 hours to get it! :tongue2:

I am in the Triwest region. I had to get the referral to the surgeon from my PCM. My surgeon requires the free seminar. Once I attended that and sent back the paperwork they gave at the seminar, I was able to schedule my initial consult. It was postponed twice because of things on their end. I met with the surgeon, finally got my psych eval and it should be at Tricare now....just waiting to hear if it was approved.

I am 5'1" and weighed in at 220. I have GERD and my blood pressure is borderline at this point. We will see what Tricare says. **keeping my fingers crossed**

The nurse at my surgeon's office that handles all the insurance stuff says Tricare is the least predictable and every time she thinks she has them figured out, they do something to surprise her.

[Rdy4ANewLife 3]

I'm Tricare Prime as well and all that they required for me was a Psych Eval. The process has been pretty smooth for me so far! After my psych eval, the doc sent everything into Tricare for approval and I was approved 2 days later!

Approved: January 20th, 2009

[ashleyb 0]

i have tricare prime..and I didn't have any problems getting approved. No one even told me I could be denied! I just went to my pcm said I wanted to look into the surgery and she refered me and then like a month later I went and had all the stuff done I needed to do ...lab work, psyc, nutrition class, 2 wlsg meetings, Galbladder scan. and an eeg. After that I was put on the waiting list, and im stil waiting!!! It's for ever sometimes depending on where your stationed if your in the military I was at fort gordon and there was no waiting list, now at fort Bliss the waiting list is 9 month's to a year! Sucks so bad, but nothing we can do but wait!! Good luck with your journey!

Ashley

[Tiffykins 672]

I have Tricare Prime. I had my first surgical consult on 7/22/08, my pysch and nutrition eval was 7/29/08, and my surgery was approved literally 10 days later.

I had/have ZERO co-morbidities, my height/weight was 5'2"/270, so I was clearly 100lbs over my ideal weight by the MetLife. I am consider "medium" frame by the insurance standards therefore my approval was very quick. I did not have to complete any pre-surgery diet, or observations. I filled out the questionaires and a 7 day food log.

Tricare Prime isn't typically that difficult to get approval through, it really depends on how your surgeon's office codes everything and gets you in the system. At least that was my experience. Pretty much, my surgeon's nurse told me exactly what she was going to do to get me approved even though I had zero weight related medical problems.

[wintobethin 5]

Tricare Prime here. Was just banded on January 16th and just had my 2 week post-op on base. My surgery was done on base as we have 2 Bariatric surgeons stationed here. The wait was a little long I thought. Had to have Psych eval, diet class (2) WL support group meetings (2) and Lab work. It just seemed like it took forever to get everything lined up. I started the process around August of 08 and finally saw the surgeon the first part of December for a January 16th date. I have high blood pressure, sleep Apnea, arthritus (sp). I did not have to have upper GI, EEG, or anything like that before surgery. Oh, did have EKG and chest Xray right before surgery and more labs! The also wanted to know when was my last pap, Colonoscopie and what other surgeries I had and what year. They just want to make sure you are in super good shape!!!!!!!!!!!:tongue:

[Jade810 0]

I have tricare and it was a pretty easy process for me. Be carefull though they have strict requirements. here is what they require.

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)

Other then that I LOVED getting banded with my insurance ...its 100 percent covered :cursing:

I don't under stand what this means:

"Is 200 percent or more over ideal weight for height and bone structure"

I'm 230lbs. and I'm 5'2". As far as I know my BMI is 40 at least.

Am I also understanding that you have to have already had an unsuccessful weight loss surgery?

"Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery"

Because if that is the case then I'll have to get something besides lapband surgery. I haven't had any surgeries yet. I don't even know now if I'll qualify. I'm now very confused.

[help1977 0]

Jade First do you have Trime Prime? Because I can only tell you what I know with them. With me I am 265lbs at 5'5. Tricare Prime goes by the MetLife chart (med frame) That means I should weigh 127 - 141. So I should lose about 124lbs (damm thats more then my 24yr old daughter weights lol) I never had surgery before. I have hypertension and multiple chronic joint pains. Ok with that said Tricare approved me in 2 days. I hope this helps. You can also call Tricare and they would be glad to answer any of your questions. I know they were a big help for me. Good Luck

[haroldrussi 0]

I have TRICARE Prime and my approval from TRICARE came within 24 hours of the Dr.'s office submitting it. I saw my Dr. yesterday (3 Feb) and surgery is scheduled for 4 March. Like the above have stated, if you meet the weight requirements TRICARE usually approves. My wife was also approved but decided yesterday while talking to the DR. to change to a bypass (more weight loss capability and better blood pressure control.) I am staying with the band.

[topless muffin 0]

Hi, so glad to see this thread! I had an appointment with my PCM yesterday and she was the one that actually suggested banding. I had never really considered it before so now I'm looking into it.

I'm 5'7", 264, 41 BMI, with hypertension, chronic joint pain, and am pre-diabetic. (Ew, I've never typed that out before.)

In the bit of research I've done, I have seen people talking about the cost of the fills. Does Tricare also take care of that, or is it just the surgery?

Thanks!!

[help1977 0]

welcome to LBT As far as know Tricare does pay for fills. And I can say during my process Tricare has been great. I can't tell you how many times I called them with a question. This is a good site, you can get alot of questions answer from people that has already gone thru it.