Tricare/Triwest covered vs not covered

Hello Military Family I'm new to the this site...didn't know you were here...Armywife myself and I have triwest....Tricare just in the west. We are stationed in southern california. I have been getting missed information is their anything tricare will not cover for RNY?

I have Tricare Prime.  We are in NC.  When I was having all my test done, the only thing that I had to pay for out of pocket was for the nutritionist.  Everything else was covered.  I am not saying that is what will happen with you, but that was how mine went.  The best advice I can offer is to call Tricare and ask them all the questions you have.  They can tell you better than anyone else. 

Good luck to you.  The journey will be worth it. 

Thanks so much for the information. Triwest isn't that helpful but this helps thanks so much for the post.  

The RNY should be covered by Tricare no matter where you live as long as you meet the weight and co-morbidity requirements. 

Red

I just came from Triwest and went through the whole process but not surgery and I never had to pay out of pocket for anything.  I never seen that anyone was paying out of pocket for anything.  I am hoping it will be the same way here just with better Drs here so I can actually get surgery doen this time.

Tricare Prime - North Region.  Here is the information you need, along with the steps you may need to take, but verify with Tricare first.

Gastric bypass, gastric stapling, gastroplasty, and vertical banded gastroplasty are covered. Laparoscopic adjustable gastric banding is covered effective February 1, 2007. (view Hospitalization Costs):

The following conditions must be met:

• The patient is 100 pounds over the ideal weight for height and bone structure and has one of these associated medical conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic disorders and severe arthritis of the weight-bearing joints; or
• The patient is 200 percent or more of the ideal weight for height and bone structure, regardless of associated medical conditions; and
• InterQual^® criteria is used during the authorization process to determine if the requested surgery is appropriate and medically necessary. (InterQual^® is a widely used product of McKesson Corporation that provides evidence-based clinical decision support for health plans, hospitals, government payors, and various other organizations.)

Authorization Requirements
TRICARE Prime beneficiaries require prior-authorization for all non-emergency inpatient procedures. 

The following services are excluded (this list is not exhaustive):

• Office visits solely for the treatment of obesity
• Non-surgical procedures for treatment of obesity
• Biliopancreatic bypass (jejunoileal bypass, Scopinaro procedure) (CPT codes 43645, 43845, 43847 or 43633).
• Gastric bubble or balloon
• Gastric wrapping/open gastric banding (CPT code 43843)
• Unlisted CPT codes 43659 (laparoscopy procedure, stomach); 43999 (open procedure, stomach); and 49329 (laparoscopy procedure, abdomen, peritoneum and omentum).

Depending on what level of service you have, you will need a referral from your PCM (primary care).