Question:
Does anyone have experience with Tricare Prime Appeal of Denial of Surgery?

I could sure use some help in appealing a denial by Tricare Prime for lap band surgery. Can anyone offer any help?    — grandmasharon (posted on June 15, 2008)

June 15, 2008
I have tricare and I got an approval on the first time in two days...mine was for gastric bypass, what did they say the reason for denial is? Usually they are pretty good at approving.
   — Kimberlin Katayama

June 15, 2008
Give us some more detail, there are quite a few Tricare insurance holders, we just need more detail to help.
   — heartsablaze

June 15, 2008
Hhhhmm, you would think the military would pay for it, since they are pretty good about approving a lot of procedures from my experience. I used to have Tricare, and my two sons still have it. So, I know a bit about the insurance. Also, I'm having problems having the LapBand approved by my commercial insurance now and recently wrote a killer medical necessity letter. If you would like to see it, drop me a line. Shannon
   — Shannon42774

June 15, 2008
I think the key hear is LAP BAND. Last time I was in the tricare office I was told they do not cover lap band at all. You might want to looke into gastric bypass. That they do cover. Mine was approved within 30 minutes roughly lol. I was still in the hospital when the lady called to set up my appointment.
   — Navada L.

June 16, 2008
Tricare recently has approved the lapband procedure for coverage. So that's not the problem. I would suggest, your PCP write a letter and send documentation of your comorbids and see if they can waive the low weight requirement. It's new to Lapband is brand new in the Military so they are probably going to be very strict until they are comfortable/familiar with the results... Good luck with whatever happens.
   — .Anita R.

June 16, 2008
I was approved in one day with one comorbidity and my BMI...they do cover LAPBAND now...TRICARE has always been very good since I have been with them the past 2 years...good luck to you
   — [Deactivated Member]

June 16, 2008
I was at a Q & A session for WLS at Madigan Army Hospital and they said TriCare will not cover Lapband fills. If you can get them at a military treatment facility there isn't a problem. I am having a lap RNY there next week. lisa
   — Lisa B.

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