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Tricare Prime and Lap Band

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.

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The only thing you have to be careful of is the approval dates. If you are only approved for Referal visits till 1 Feb and go to an appt on 3 Feb TRICARE will not pay for the appt. Pleeeeese watch your dates. My wife's was just like above and I just found this information yesterday. TRICARE will not budge....

  • Author

Ok well I just got a call from my doctor and Tricare approved the consultation. So I guess my next step is to got o the seminar and then the consultation. I hope everything goes well!

Regarding the referral, make sure your PCM's office puts "to diagnose and TREAT obesity" that is some of the wording that Tricare requires for the referral to be approved and for you not to run into issues for future appointments. Apparently, the word " treat " is the keyword that Tricare looks for in their approval process and for aftercare appointments.I had to get my PCM to edit his letter of referral so Tricare would approve all of my visits.

My fills and follow up appointments have been covered 100% with zero out of pocket cost. I have Prime, but I have a civilian PCM and civilian surgoen due to our MTF always being overbooked. . .

  • Author

Ok thanks for the info! I also have a suvillian doctor. Hopefully I can get as lucky as you.

i got the referral from a doc to see the surgeon, and had my first appointment in early december. they submitted the referral for the surgery and said call with the date i want. my surgery is scheduled for march 17th. it could have been earlier, but i need my sister to come help with the baby, so i had to schedule around her spring break.

ive only actually seen the surgeon once, and then my 2week pre-op appointment is scheduled too.

its been easy, but im nervous

ok, i read the rest of the posts, and i feel lucky. i didnt have to have any tests, or nutrition classes or a psych eval or anything done.

I was just called by TRICARE Thursday evening telling me that my surgery was all approved and that if I had any questions about the procedure to just call them and they would help. What a surprise! Can't hardly wait till 4 March date of my surgery. Monday my wife and I go to the pre-op classes from 430-830. I guess if I still have any questions by then I can get them answered.

  • 1 month later...
  • Author

I got the seminar all done! Tricare approved my consultation visit with the surgeon. It is April 2nd! I cant wait. Hopefully everything still goes smooth!

Hi,

I have just been approved through tri-care prime. I started my quest back in December, I tried going through the naval hospital. Unfortunately the wait list was quite long, in addition they were losing 2 surgeons. Nonetheless, I was number 197 and currently they are on number 135. I at the same time, looked into surgery through a civilian doctor. I received referrels from my pcm and two other specialty doctors with the Navy. Tri-care approved me for the surgery out in the civilian sector! The wait process i thought would be two to three weeks< IT WASN't one week and now I am on my way.

Good luck to you!

  • Author

Wow! Congrats! I also have a civilian doctor. Was it hard to get approved through tricare? What is your bmi?

  • Author

Ok! I went to my consultation today to see the lap band surgeon. It went great. He approved me for the lap band! Now as long as tricare prime approves me everything will be great. I have to go see if I have GERD (acid reflex) and go get my blood taken for different tests. I also did my chest x-ray today. So after thats all done then I will hopfully get a surgery date........:smile2:

Yay! That's great that the surgeon is for sure on your side! I also just had my initial consultation today and am hoping that I'll be one of the few that get it approved within a matter of days:tongue: From what I gather from this site, Tricare seems to be top notch at approving you the first time if you meet their criteria(which someone was kind enough to look up and post earlier). I'm 5'4 and 265 with hypertension and sleap apnea so I damn sure better be approved or their phones will be ringin of the hook!! I was actually surprised when my pcm wanted me to go do a sleep study because I was feeling overly tired durning the day, but sure enough it turned out that I was stopping breathing too long over 30 times an hour!! News to me:ohmy: Anyhoo, here's to getting banded around the same time eh?!!! Keep us posted!

Hi my name is Gwen and i too have tri care and i had know problem they approved me with know. I had my surgery on jan 12. You have make sure you do what ever there requirements are and they will approve it in no time. I think you have to have tri care standard if you call tri care they will tell you so that you can switch to the one you need thats what i had to do. I hope this information herlped you.

Gwen

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