lap band adjustment not covered by triwest military insurance?

i have a lap band on my gastric bypass pouch. my pcp requested i get a referral to get the band adjusted. tricare is telling me the adjustment isnt covered by the insurance. has anyone had this problem? karen

Sorry, Karen. I don't know about this. Did Tricare cover your band placement? Its weird if they did that, and then didn't cover your fills. It sounds to me like you need to contest this with your insurance company, if they did indeed cover the placement of your band. Good luck and let us know! ~Tiffany

That was one of the things my surgeon warned me of, that some pay for the procedure but not the fills. I don't think it is out of the ordinary for some companies but I would still fight it with all my might. Good luck!

I work in the medical insurance industry and if just talking to the up front people then may i suggest the following: first get a case manager at triwest. second have your dr write a letter specific to the cause as to why the adjustment is needed. you will have to show your progress but also what you have done and that it is not working and the adjustment is needed expecially if you can still tie this into a medical need like high blood pressure, knee problems what ever you can tie it to. basically any insurance is trying to not keep paying for new surgeries or continued surgeries and they only want to do it once. case in point my cousin had the military cover her surgery but it was not lap band anyway the interns who performed the org surgery left the pouch to large so she hit a platue and had to go back in for a redo. it was like pulling teeth but her surgeon pulled the paper, pen and back up support out and it was granted. good luck and keep the faith. the fight is worth it but get one specific person to talk to and deal with it is alot easier. wendy cox, kansas city