Tricare

dallman

Has anyone heard of any changes to tricare standard covering the Lap Band? Any future changes? This sure is a long process to get coverage that should have been covered when the VA and Medicare started approving the Lap Band.:cry

Thanks,
Don

orrn

I too am frustrated w/ all the things that tricare will and willnot pay. They agree to pay for gb but not for lap..... Too me the lap would be less invasive to start with, you?
I will make a phone call and talk with them, they are the ones I started with. They referred me to a physcian on the list and I went to the siminar. Very educational. The dr also said he had been dealing w/ tricare for over 3 years to get lap band covered.
Don't you feel like we could do something to get the ball going?

dallman

There was another person on this board that seemed to have an inside line on what was going on with Tricare. I hoped to get a response from them. I can only wait so long and them I will have to self pay. It is a crying shame that if I had Champus or Medicare I could get the lap band done with no problem. I have contacted senators and congressman and gotten form letters in return. I only say keep making noise maybe someone will hear.

Don:(

orrn

Good news today! I went to my tricare office and spoke with them. They said tricare is covering lapbands now. I showed her some of my research that lb has it's own cpt code 43770 released Jan 06. She seemed to be really impressed that I had this info. Only problem, my pcm put in the referral for gastric bypass and to TALK about lap band! Now I have to have another referral for lap band and I will have them include the dr that will do the surgery that takes tricare!!! I hope this works. The tricare lady was absolutely great! She did say you have to stay on top of this. Let me know what you find out after you talk w/ them.

lexysmommy

I was so excited to see this that I called Tricare South to verify and get that ball rolling again, so i could bypass aetna and they told me that they are NOT covering it, that there has been no changes. :frusty: I just do not understand how they can cover the darn bypass and still say no to the band, its sooooo much safer and less expensive. Please please please keep us updated on how this works out for you. I'm hoping that maybe we are in a different region and mine just hasn't caught up yet. :help:

dallman

I e-mailed to the tricare headquarters and they are still not authorizing the band. Maybe next year.

Don

Boo Boo Kitty

I don't understand why Tri care does not pay for the band. I have Champva, which is for those family members that are military disabled. They do pay. I would ask them why Champva pays and not Tricare. It is just stupid!

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lexysmommy

What exactly is Champva? I'm a disabled veteren, with service connected, should i be trying to go through them for this?

dallman

Champ/Va is authorizing the band. If you can use the Va you should.

Don

lisawynita

You are saying that Tricare will pay for lap bands? As of when? I had my Lap Band done at Walter Reed Feb 2006. I am now in Kansas and Tricare is telling me that they will not pay for lap bands or the fills that you need after you get the lap band. I even had a referral from my PCM to get my lap band fill. They paid for me to see the Dr. but will not pay for the fills after I already had two fills done. At firtst they said that K.U. did not get prior authorization so when I appealed it they sent me a letter telling me that the lap band has been unproven so therefor the adjustments are specifically excluded from Tricare coverage. So I am stuck with a lap band that does me no good if you can't get the fills. Please send any info that you have. I am at the point of paying for the fills my self. I have not lost any wieght in 9 month and have gained almost 10 back from what I did lose.

Boo Boo Kitty

If you are 100% service connected permanently and totally disabled you should have Champva. It is free, they pay 75% of everything you pay 25%. PM me if you have questions.

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lexysmommy

Nope, i'm only 50% service connected :(

dallman

They have been talking about a doctor in Denver that does fills for 15.00. Hope you are close to there.

Don

orrn

Well, I went to the tricare office here at Randolph AFB and the clerk gave me the provider directory. There is one dr that does take tricare and does both lap band and gb. All I needed was a referral for Lap Band and if the military does not do this, (which they do not!) it should be kicked back and tricare should find a provider from the directory to full-fill the referral. That is what I did Friday was get the referral. They have ten days!! We will see.:nervous

lisawynita

As for me I had a refferal from my PCM but Tricare still will not pay for Lap Band fills. I hope it works better for you.