Question:
Anyone with Tricare Prime with approval information. I am wishing for the lap band.

I am hoping to have lap band surgery in South Mississippi or Southern Louisiana. Need information on Tricare Prime insurance approval.    — Kennedy89 (posted on January 25, 2009)

January 25, 2009
i have tricare prime and had no problem getting approved. i went through my 6 months and im waiting for the nurse to call me with my date! im so excited. at first i wanted to do the lap band but i am now going for the RNY. good luck!
   — esty

January 25, 2009
Tricare just recently approved Lap Band this past year. Until then, they only did RNY. I was approved within days for RNY...however actually having the surgery took a year. That was 5 years ago...Many Military Hospitals now have a bariatric surgeon at their hospitals. I had to go thru a civilian surgeon from their list of approved surgeons (who had a six month waiting list just for a consultation) and now I am stuck because I am not allowed to see him unless I get approval from my PCP at our clinic who is absolutely and completely uneducated in the GB body and what is required for proper care...SO...I have had to become my own health care advocate...I have had to learn what tests and labs I need run and how to read the lab results as well as how to fix my own vitamin deficiencies by learning how my body works and absorbs vits and nutrients.It's a LOT of stuff to learn! It's been a bit of a nightmare actually when I did turn up with malnutrition and anemia...Come to find out my PCP was not running the right labs for 3 years and I had gotten really low on vits and pretty sick...SO...ASK about after care! Be aware that you MIGHT have to go thru Champus or get approval for fills and health care if you are not near a military hospital or clinic that has a bariatric unit...Like me! I have to go thru the hassle of making an appointment (that could take days just to get a live person on the line) and wait a good month just to see my PCP so she can arrange a refferal IF she feels I need one...THEN I have to wait for it to be approved and make the appointment to see my surgeon which can take ANOTHER month...And by that time (2-3 months later) I might as well just know what tests to run and not even bother! SO I do my own research and stay up to date....because my surgeon is a 4 hour drive (to and from) on top of all of that... Not worth it! Just so you know what to expect if you are going to different duty stations or do not use a hospital but a clinic where they probably won't have a bariatric doc...
   — .Anita R.

January 25, 2009
I had tricare standard and it covered it. From my first dr visit to surgery was 6 months. You had critia to meet ...such as 100 lbs over weight and another co-morbidity..with for me was high blood pressure. Best of luck! hugs,kim
   — gpcmist

January 25, 2009
Well I too have Tricare Prime and was shocked at how quickly I got approved. I was only 85-90 pounds over weight with just severe arthritis in my neck back and hips but I also had "female" problems for nearly 2 years that they couldnt get under control. So the doc who was'nt even my PCP put in the request and within a week I was approved although it took over a year to get the surgery. I went to the first class in October 2007 and could have had the surgery in July 2008 but I couldnt at that time so I ended up having to wait until December 2008. So it was pretty fast getting most the pre-op approvals done (psych,nut,xray,labsand so on)psych took the longest. But here in Virginia ALL of our after care is by the surgeon for 18 months. Then after that we are sent back to our PCP. Oh yeah but I didnt have lapband I had bypass. I dont think it is much different. Atleast here. So just check on this site and see if there is anyone else who has had the lapband in your state to see what they had to go through with their docs. Good luck and it will be a hard journey but its one of those journeys worth taking. Good luck to you and God Bless.
   — mother2mykids

January 25, 2009
I had RNY in June 2007. At that time, Tricare Prime wouldn't approve lap band. They were excellent though at approval of my gastric bypass. I would check the website each day and one morning it was pending. By late afternoon, I was approved! I have been extremely happy with Tricare Prime. My hospital bill was $25, definitely can't beat that! Good luck to you!
   — Cindy H.

January 26, 2009
I have Tricare Standard. I started the process on March 26 and had surgery on July 25. My husband started the process about one month after I did, but we both had surgery on the same day. Tricare was great!
   — cindygw

January 26, 2009
I have Tricare Prime with Triwest. Heard that each region is different. With Triwest you have to be 100 pounds overweight with at least one co-morbidity, or 200% overweight. What that means if for your body frame you should weigh 130, but you weigh 260 you will be approved. I do have a few minor co-morbidities, infertility, GERD, and back pain. I was afraid that I wouldn't get approved. I had an appointment with my PCM on, October 31, 2008, he sent in a referral for a surgical consult. The base we are at is just a clinic base so I am going off base for everything related to my surgery. I had my surgical consult approval on the following Monday. However, the doctor they approved no longer does that surgery. After a few phone calls to other doctors listed on Tricare's website I had to call Tricare as no doctor in the immediate area does bariatric surgery. They referred me to a bariatric practice in Salt Lake City, only 45 minutes away. I called that clinic and had to go to a seminar before I could even get an appointment for that surgical consult. This is pretty standard. I attended the seminar the middle of November, and had my initial consult with the surgeon on December 11th. The surgeon wanted to do an EGD before my surgery but I couldn't get that done until January 6th. It took awhile for the surgeon to print up his report on the EGD, but I called them every week to remind them that I am still waiting. Their insurance specialist assured me that she would submit my paperwork to Tricare last Thursday or Friday. I was OBSESSED with checking the Triwest website to see if it had been submitted. Friday afternoon I decided to check one last time before the weekend, and I had been approved. It took them less than 24 hours to approve me. I have heard of other regions requiring a 6 month diet...so far Triwest has not asked that of me. I wish you all the best in your journey. I have heard from friends that Tricare is the easiest and the quickest as far as approval goes...they sure were pretty quick when it came to all my approvals. The waiting for me has been getting appointments. One last piece of advice, as I had to learn the hard way. If your surgeon requires you to see a psychologist, as most do, get your PCM to put in a referral to you first. Otherwise you run the risk of not being reimbursed.
   — lmw9674

January 26, 2009
I have Tricare Prime and my approval was the easiest thing ever. I didn't have to do a 6 month watch of my weight because my physician could clearly see it has been something I've battled my whole life (I've had Tricare prime since I was a baby and now have it under my husband). My referral was submitted and I was approved in just a few days. Two weeks later, I had RNY. I originally was going to do the Lap Band, but decided against it..but the approval was valid for either surgery...so, no problems for me. Good luck! :-)
   — Brandy H.

January 27, 2009
I live in West Tennessee and have Tricare Standard. They actually gave me a list of doctors and their locations to have the lap band. From the first visit, 9/9/08 (seminar) until my surgery date (2/2/09) is how long it has taken to jump through the hoops, which has seemed longer than it really was. Once I did all that was required by my surgeon, I had my approval in less than 48 hours from Tricare. Hope this helps. Donna
   — donnapusser

January 27, 2009
I have Tricare and I am in Mississippi. I did not have the lapband , I had gastric bypass and I had no problems getting approved. I wanted to have the lapband but medically I did not qualify because I have an autoimmune disorder. After I completed my requirements from the surgeon the paperwork for approval was submitted and I was approved for surgery within 4 days. I could have had the surgery before the date I did but I put it off due to DH TDY's and DS school schedule. All of the people I know from this base had the RNY instead of lap band so I don't know a lot about the approval rating for that. I had my surgery at UAB and my surgeon was Dr. Ronald Clements. He and his staff are all super people to work with. Good luck. I have lost 98 Lbs since July 9 and I feel awesome, I have had no side effects at all.
   — im3d2

Click Here to Return