How good is tri-care at approving wls?

I'm a air force retiree dependant and am looking into wls as i'm sick and tired of fighting the 'GOOD' fight to just be able to stay at 227. has anybody had wls and used tri-care as the ins.provider and how were they?

If you want to have the RNY they are pretty good. You must either be 100 lbs overweight with at least one co-morbidity or at least 200% overweight with no co-morbidities. Do you have Tricare standard or prime? Red

Sally, I was told by Dr. Webbs office in Jacksonville that if you are going to have lap band you have to have Tricare Standard but for open RNY you need to have Tricare Prime. I have also been told that Tricare is one of the easiest to get approval from. I have Tricare Prime and had no problem getting the authorization for the consult but haven't had my paperwork submitted yet because I have to lose 34 more lbs. to get a heart cath before my cardiologist will clear me for WLS and by then I will need a new referral. Good luck to you and just get on the phone with the surgeon you want to use and with Tricare and find out what the current policy is. Hope all goes well for you! Kat

I would be very surprised if Lap band is covered by any Tricare policy. But RNY whether open or Lap is easily covered by either standard or prime if you meet the criteria. Red

Hi Sally, I have tricare prime and once all my paper work was submitted to them I was approved in less then a week, I think it was in like 3 days. Two other ladies had surgery the same day as myself and the husbands were both retired military also. Good luck, Stephanie

Sally- Just be sure you find a surgeon that accepts Tricare assignment. If the surgeon accepts assignment they will do all of the paperwork for the pre-authorization for you. If you meet the criteria it is not that difficult to get pre-authorization for the RNY, either LAP or open. However at 227 how tall are you? You need to be at least 100 lbs overweight with at least one co-morbidity or at least 200% over ideal weight with no co-morbidities. They are really strict on this point. They do not use BMI. They use the Metropolitan weight tables. Red

Red, You may well be right. I do know that they absolutely told me that if I was having laproscopic surgery I would have to change my insurance from Tricare Prime to Standard. They didn't really know why and I didn't get further into it because I wasn't a candidate for surgery with them (BMI too high) and was referred to Ocala for open RNY. Didn't mean to mislead I was only reporting what I was told. Kat

Hello Sally , By the looks of things , you have a super chance with your insurance. Hope your lab work went well today. From your Dear Sister In Law, Allison

I was told you had to have BMI of 35 with comorbids or 40 without. I am going through Dr. Webb in Jacksonville. My BMI is 36-37 and I am in the middle of getting approved.