Question:
Tricare stops WLS surgery?
Is it true Tricare is not covering Lap WLS anymore? I also hear that they pay only 25% for open. Supposedly this started September 2004. — Sara H. (posted on January 29, 2005)
January 29, 2005
As far as I know its not true. My daughter just had Open Gastric Bypass
11/04. They stopped covering the laparoscopic RNY in 1/04. Here is a web
page with their answer on Q&A.
http://www.tricare.osd.mil/faqs/question.aspx?ID=1218&page=0&search=gastric%20bypass&click=ibGo.X
— jenafwife
January 29, 2005
I had my surgery on 11/15/2004 Tricare pays for open RNY and if you are
retired your share is 25% they pay the rest. As of today they have denied
all my bills. They have to go thru my primary Cigna first for denial.
— zachery1
January 29, 2005
as of last week, talking to tricare (Healthnet) for the northern region.
they do still cover wls. and was told they have resently started covering
lap. this is for tricare prime. not sure what standard pays.
— aunt-dotdot
January 29, 2005
You need to call Tricare yourself and see what your region is doing. I am
in Tricare North and I just had open RNY and they covered all of it. They
have also reconsidered their position on Lap RNY and are approving that now
as well. HTH. I just had mine on 1/19/05.
— MagickalMom
January 29, 2005
It must be different for each area. In Virginia we're still covered 100%.
Most docs do lap, but open if necessary. This is with our wonderful
military surgeons. I'm not sure what they do if you seek your own doc out.
Best of luck to you!
~christi
lap RNY 10/27/04
— christi_in_VA
January 30, 2005
yes they still cover it I had mine done in march and they paid 100% and I
am retired miltary wife.
— poppink
January 30, 2005
I just got appoved last week. they would only appove open r n y i'
Barb
— barbwade
January 31, 2005
Hello Sara,
It truly depends on your area. I know in the North and West region they are
still approving Lap. However in the South, which is covered by Humana, it
is not a covered benefit. What most surgeons are doing down here is
submitting the request for authorization as "Open" but doing the
procedure "Lap".
— Tiff's On a Mission
February 1, 2005
I was approved on 1/26/05, surgery is set for 2/11/05. Like the other post
it depends what part of Tricare (standard, extra, prime, active duty) you
have. I have Tricare Prime (my husband is retired Navy) and so far they
have covered the cost of testing. When the nurse called me about my
approval I had asked about the referal and she told me that I only need the
referal for the 1st consult, after that all will be handled by her. My
best answer is to call Tricare and ask them any question you may have. If
you know which surgeon you want to have call their office and ask for the
tax id #, it will help alot when asking Tricare if they are a network or
non-network provider. If you need any other help, please e-mail me.
— essie13
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