anyone with Tricapare been approved for lapband over gastric by-pass

spottydotty
on 5/20/12 3:07 am - Jacksonville, NC
I have tricare prime and have been denied approval for a revision in my 2000 gastric by-pass with a lap band.  I was wondering if anyone has Tricare and been approved for this surgery.  I know they provide lap band coverage and am unsure why they wouldn't approve the lapband over gastric by-pass.  If anyone has any insight or advise they can offer it would greatly be appreciated.
(deactivated member)
on 5/20/12 3:18 am - NC
i also have tri care prime and was approved for lap band. not sure why they would not unless you didnt have the things required (apena, diabetes etc). 
spottydotty
on 5/20/12 3:52 am - Jacksonville, NC
No I have hpertension and diabetes plus a hernia so not sure why I was denied.  Keeping positive thoughts and hoping they appeal and I get approved.
Nic M
on 5/20/12 4:20 am
Do you have the required rider on your insurance policy?
Some insurance companies are implementing a "one WLS per lifetime" clause, too, so that might be affecting your eligibility.

You'd need to talk to someone at the insurance company and find out the exact reason you're not being approved. When you know that, you can appeal or add the required rider.

 

 Avoid kemmerling, Green Bay, WI

 

(deactivated member)
on 5/21/12 1:06 am - Wiesbaden, Germany
DS on 10/08/13
The Band over Bypass (BoB) is not the prescribed use of LapBand or Realize.  It is OFF LABEL.  As such, you may encounter great difficulties that that particular revision.

Why do you want/need to revise and what's the reason for electing this particular revision?  It makes a huge difference in how to approach TriCare or an other insurance company.

Have you been on the revisions board?  I think you might get some good information there if you do a cross-posting there.

I'm not a LapBand fan and I don't personally endorse BoB but I don't know what is driving your quest.  So, unless you contact me, I won't go down that particular stretch of highway.  But you are welcome to send me a PM.

Lisa
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