Question:
Tricare and Lap surgery

Anyone with Tricare know who and how to contact about the unapproval of Lap surgery. Maybe if enough of us spoke up they would change the policy back to approving it again.    — rachgrizzaffi (posted on January 22, 2006)

January 22, 2006
Hi Rachel! I have TriCare and I got approved real fast (less than 3 days) for a Lap RNY. I had a BMI >40 and some comorbidities. The insurance covered it all and I never even had to talk with them myself. What you need to to is to find a doctor in your area that accept TriCare and maybe even like my doctor, have a deal with TriCare, I know that there are more clinics and doctors out there that cut these deals with TriCare. Good luck! Magdalena
   — eandtuta

January 22, 2006
Could you post some more information about Tricare denying Lap surgery? My neighbor had a lap RNY done about 6 weeks ago and it was all approved. Is this something really recent?
   — Jenn K

January 22, 2006
Rachel, I used tricare and just had my surgery Jan 3 2006, they approved me with no problem and I found out it is because of your PCP and the doc that is gonna do your surgery if he is on the approval list. You can email me if you have questions. Tina
   — fitn06

January 22, 2006
TriCare approved my DS/ then withdrew as being underweight, then approved on appeal because I forced them to accept the records from My VA/PCP that I did meet criteria,TC doesnt use bmi, then they denied because they decided to exclude the DS after they jerked me around, but my service connected condition that prevents my having either the band or rny dictates the DS caused my entitled ment to tricare, MEDICARE, CHAMPVA,AND MEDICARE, AND THE HEALTH PLAN FOR CONGRESS ALL PROVIDE THE DS, just tricare that covers active military, the retired career, and the disabled service members and their family, medal of honor winners and POW, My congress man feels this is a injustice and is taking up my cause to overturn my denial, I suggest that you contact your congressman. also two congressmen have had the DS, congress Jesse Jackson of Chicago Ill, and Cong Mayne of NY. Both on the government health plan. An alternative to the band,that I would consider,if weight loss was my soal goal from wls,since i cannot have a band, I am a light weight , I really am interested in the 98$ cure rate that that the ids does for diabetes ,rny does not, would be the vsg , it is the top of the DS, I believe it is superior to the band, much lest hassle, permanent and better performing , visit the vsg forum. just my opinion
   — walter A.

January 22, 2006
Rachel, I am assuming you are talking about LapBand surgery or are you talking about laproscopic surgery? I had a laproscopic RNY done and it all was covered by Tricare. I heard from others that LapBand was not covered by Tricare. Is there a message group for lapBand patients? If so, maybe they could help. Smile, Jenna
   — jstatkus

January 22, 2006
Jenna asked the same question I have. Are you referring to Laproscopic surgery or LapBand? I am sure the reason lapband is not approved is that the success rate for maintaining the weightloss isn't up to snuff with RNY surgery. I chose RNY because it was an approved wls for Kaiser AND more importantly, it has a higher success rate in weightloss and maintenance of the weightloss. I have lost over 100 pounds several times in the last 30 years, but failed to keep it off. My goal is to lose it again and keep it off this time and with the tool of RNY, I believe my chances of success are high! Lap vs Lapband.......can be confusing, so be more specific in the weight loss tool you are referring to. Thanks and good luck!
   — LauraA

January 22, 2006
I had agrued with Tricare about the non-approval of LapBand surgery...pointed out that it's less invasive, etc....the short answer is that the person still has the possibility of "eating around" the band. Granted, if you are serious and ready to change your habits this shouldn't happen, but that's their basic answer. I asked how to get that changed and was told to write my Congressman as well as submit it to the AFAP meetings (you know, the Army Action group that has boxes around post whenever they get ready for a conference). On the plus side, I had lap gastric bypass in October and come through with flying colors- Tricare paid the whole thing except for nutrition and excersice consult (because I didn't want to wait for an opening at Ft Hood and went with my surgeon's group)
   — Ravenwulf

January 23, 2006
I have Tricare and had no problem getting approved. While we lived in Virginia, the waiting list for the RNY surgery was extensive, but we've since moved to Hawaii, and I haven't waited that long, and my surgery date is next month. Just be persistent--LOL, that's how I was...both with your PCM and with Tricare!! Good Luck to you. Also...get everything you can think of documented (healthwise)...Tricare looks at it, when/if you get a surgeon when he/she writes your letter for approval it will need to be in your record.
   — jessica7552

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