Question:
Will Tricare pay for any portion of lapband surgery?

Since Tricare won't pay for lapband surgery, will they pay for any related costs, such as hospital stay or for a re-operation should one become necessary?    — Randie (posted on August 26, 2006)

August 26, 2006
i dotn know the answer to that but i would say no only because it is still classified as a experimental procedure by tricare.
   — cyndie M.

August 26, 2006
I'm going through the same thing with my insurance right now. Have you appealed the decision yet? Medicade has now approved the lap-band so it's only a matter of time before the rest follow. Hang in there!!!
   — erothell

August 26, 2006
Cyndi: Change 42 of Tricare Policy manual 6010.54-M removed the "unproven" or experimental verbiage and announced that Laparascopy has been approved since 2004. Change 43 onward put the unproven verbiage back in. I suspect Tricare is playing coverage games and using the policy manual to do it. Regardless of the games Tricare is currently playing, there is mounds of evidence to the contrary for the procedure being experimental. If there weren't, believe me, Medicare and CHAMPVA would not be approving the procedure and the VA would not have 13 facilities that perform the procedure.
   — Randie

August 26, 2006
Eric: Both Medicare and CHAMPVA now cover lapband, but Tricare still does not. I was told by the local Tricare service representative that the Tricare contract is due to be updated in January 2007. However, no one knows if the lapband wil be covered at that time or what new hoops Tricare will have lapband applicants jump though. What I do know is that Medicare added a "Center of Excellence" hoop to their requirements and Tricare will probably follow suit. Why? Because there's only a handful of those right now which greatly limits facilities available to have the surgery.
   — Randie

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