Tricare Prime

I already have my band but I have a friend that will be going to Mexico with me on Saturday to check out my doc and hospital. Before we go I would like to verify if her insurance will cover a band. She is not interested in anything except a Lap Band. Does ANYONE know if Tricare Prime will cover such a procedure? I could really use this info before Friday if at all possible. I'd love it if her insurance would cover this vs. paying out of pocket. Thx!

Best thing for your friend to do is to call her insurance company and ask them. They will give her all the information she needs.

She's been trying to call them but being the time of year it is she is unable to get through. According to their website they don't pay for the band but they do pay for other bariatric procedures but not the one she wants. I was hoping there was a way to get around the rules, thus my question here.

Sorry... but each insurance company is different from year to year and one person may be approved and another declined. It's all case by case. Just because one member on this site may be approved, it doesn't guarantee the next person will be. That's why its best to get the correct information from the insurance company.

Yes, I am aware of that. Thus, the reason for my question. According to the insurance co's website this procedure is not covered. Period. However, another person responding explained that this insurance company does make exceptions under the right cir****tances. I am aware that just because an exception is made for one person it will not be made for another. But sharing info here is quite helpful and any tips and tricks are appreciated. Thx!

Tricare Prime denied the band for me, but approved the RNY. I recently called them and they said it's extremely difficult to even get approved for the RNY now. The best thing she can do is try to get approved here first before having it done in Mexico. There's always exceptions that can be made and she may be able to find a local doctor that has a good argumentive letter to get her approved for the band. Hope that helps some, Nancy

Thanks. I think what we'll do is go to Mexico Saturday just to check everything out. She's going with me to my f/u appt. She can see it, get the standard lectures, understand how it works, and then she can come back here and try to get approved. So far it does not appear to be looking good that insurance will pay for it. Thanks again!

What doc is she going to see in Mex? There are many great ones. I had the band placed by Alberto Aceves in Mexicali (1 hr west of Yuma) and have had fantastic results.

Yep, that's the one, Dr. Aceves. Wouldn't dream of going to anyone else. It was the best decision I could have ever made! And isn't he just a gem?

Hi, I too have Tricare Prime and when I was checking out my options discovered that they would not even consider lapbands. I checked out their website to find that information. However, I had no problem getting approved for RNY because of all my co-morbidities. Part of the problem with Tricare now is finding a doctor who takes the insurance. There is only one in the valley that I am aware of at this point since Dr. Newhoff retired. Good luck! Virginia