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Thread: Does Tricare cover Lap Band?

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    #1

    Question Does Tricare cover Lap Band?

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    Does anyone know if Tricare will cover any of the lap band weightloss procedure?



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    #2
    I don't think it covers lap bands, but I do know it covers gastric bypass


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    #3
    No. In rare instances they will with significant documented proof that the weight has caused serious medical problems, even with that they will require that you first attempt to lose weight, and sometimes they will require a restrictive diet for X amount of time. So, if you can get it approved, its usually 1-2 years before it can even happen. But, there still needs to be documented proof for X amount that the weight has caused issues and weight loss was tried on your own but failed (and will need proof that weight loss was attempted).

    Proof of weight loss would be seeing a doctor, going to a program, documented gym/exercise. A food journal (reviewed by a health professional), etc. They won't just take your word that you tried to lose weight.
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    #4
    I also believe you have to be so many pounds overweight.. I want to say 100 lbs or the BMI at or above a certain number
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    #5
    yup it is covered but needs well documentation also they don't cover the skin removal after unless there is infections of the skin etc.... but here is what I found about gastric TRICARE Beneficiaries : Covered Services - Gastric Bypass
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    #6
    Yep it covers the lapband. I had mine done in Aug 2008 right after they started approving it. You have to either have 3 health issues or be 100lbs over weight to have the surgery. I didn't have anything well documented and was approved with no issues or fight in 2 months. Also, yes tricare will pay for skin removal IF you have weightloss surgery. There have been atleast 10 girls here local that have already had their skin removal. And from what i've been told by then at our support group meetings is that tricare didn't give them any issues and they didn't have to prove skin infections.



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    #7
    Quote Originally Posted by SubmarineWife View Post
    Yep it covers the lapband. I had mine done in Aug 2008 right after they started approving it. You have to either have 3 health issues or be 100lbs over weight to have the surgery. I didn't have anything well documented and was approved with no issues or fight in 2 months. Also, yes tricare will pay for skin removal IF you have weightloss surgery. There have been atleast 10 girls here local that have already had their skin removal. And from what i've been told by then at our support group meetings is that tricare didn't give them any issues and they didn't have to prove skin infections.
    ditto

    it can depend on your PCM and the hospital.
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    #8
    I had no documentation of nutritionist, dietician, attempts to lose weight, etc. (I HAD attempted, just had no documentation from a physician.) The whole process of approval took 8 months, and only that long because I got cold feet and stopped contacting my surgeon for a few months. I had a gastric bypass, but lap-band is covered under the same stipulations: 100 pounds overweight with at least one qualifying co-morbidity, or 200% of ideal body weight for your frame (determined by a doctor or surgeon.)

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