Question over Tricare insurance

New TRICARE Policy Adds Weight-Loss Options (Article 2)

A recent change in TRICARE policy now provides coverage for laparoscopic adjustable gastric banding (Lap-Band® surgery), opening new avenues of treatment for those fighting morbid obesity. This policy change is retroactive to Feb. 1, 2007. If you’ve had Lap-Band surgery since Feb. 1, 2007, and qualify under the new policy guidelines outlined below, you may submit a claim for reimbursement or, if you submitted a claim and it was denied, you may appeal the denial.

Lap-Band surgery is a minimally invasive procedure that can help you shed excess body weight. The Lap-Band shrinks your stomach and restricts how much food you can eat at one time.

You are eligible for Lap-Band surgery if you meet any one of the following conditions:                                  

You are 100 pounds over the ideal weight for height and bone structure and have one of these associated medical conditions:

• Diabetes mellitus

   

• Hypertension

   

• Cholecystitis

   

• Narcolepsy

   

• Pickwickian syndrome (or other severe respiratory disease)

   

• Hypothalamic disorder

   

• Severe arthritis of the weight-bearing joints

   

You are 200 percent or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category.         

You have had an intestinal bypass or other surgery for obesity and, because of complications, require a second surgery (a takedown).

            For more information about Lap-Band surgery, talk to your doctor about the benefits and risks of the procedure.

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Active Duty PCM Changes Should Be Completed in Person (Article 3)

If you’re an active duty service member (ADSM) enrolled in TRICARE Prime and you’re considering changing your primary care manager (PCM), remember it is always best to make this change at your local TRICARE Service Center (TSC).

Because most ADSM PCM assignments are made by your local military treatment facility (MTF) and any change may require the approval of the MTF, the most efficient way to complete a PCM change is to visit your local TSC and submit your TRICARE Prime Enrollment Application and PCM Change Form in person.  However, you also may make a PCM change through Humana Military Healthcare Services, Inc. (Humana Military) by mail or by phone.

Note: ADSMs enrolled in TRICARE Prime may not use the TRICARE Beneficiary Web Enrollment (BWE) Web site to make PCM changes. (However, ADSMs enrolled in TRICARE Prime Remote may use BWE to change their PCM.)

Humana Military has TSCs located throughout the region, typically at or near MTFs, staffed with customer service representatives to assist you. Use the Find a Provider/TSC/MTF feature or call Humana Military at 1-800-444-5445 to find a TSC or MTF near you.