Question:
Okay need some help with Tricare coverage

I received my approval for surgery from Tricare on the 20th and was previously approved for 3 visits with the surgeon for a consult. I just received notice that they are not going to cover my consultations because they do not cover the treatment of obesity... have any of you run into this problem and how did you get it taken care of?    — Vegas_ T. (posted on July 3, 2003)

July 3, 2003
Maybe I am mis-understanding the question, but Tri-care does in fact cover gastric bypass and weight loss surgery.(I have Tri-care also) They do not however, cover other forms of weight loss methods. I am not sure who told you that your surgery would not be covered, but as long as you met the criteria, and obtained a PCP referral...it IS covered.
   — AnneK.

July 3, 2003
I would give them a call, there has been some misunderstanding. I just had surgery in May and I have Tricare Prime. They have paid for everything and I even saw a civilian. They do not treat obesity as far as pills and such goes but they DO cover WLS. Good Luck!
   — Tami H.

July 3, 2003
Tara- I too was approved for surgery and received a document from Tricare which read "This Is Not A Bill" and it also stated that Tricare did not cover the treatment of obesity. However, after speaking with Tricare it was determined that the terminology used by the surgeon for the collection of payment was incorrect. Word's are worth their weight in gold.
   — Kaprice B.

July 3, 2003
What it sounds like to me is that your doctor put in for treatment of obesity, and Tricare does not cover treatment for obesity, such as weight watcher, etc. Tricare prime does cover gastric bypass surgery, so have your doctor resubmit for gastric bypass, on the same note, some insurance companies require you to have noted documentation of weight loss attempts, since Tricare does not cover that type of treatment, they do not require documentation of weight loss attempts. I have Tricare Prime, and I thank God and my retired military husband everyday, Tricare is the best insurance, I never have had any problems ever with getting a approval. My WLS was approved in one day. Hope this helps.
   — cindy

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