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I had to pay out of pocket for the nutritionist but not the psych eval. I know it stinks but hopefully your insurance company can reimburse you.
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).
Welcome to the board.....I felt the same way about asking the PCP about a referal too....I'm a armywife and we live near a AirForce base so I didn't think they would do that for me and they did....I got my referal in less than 7 days and everything has went so stressfree on the end of tricare....They have been great. So do your research now and when you PCS in march make your appt. at the base and ask for it ASAP so when you get to PCS again you will look and feel great!!
Red
Red
I just wanted to pop over, now that I know there is a military support board and introduce myself and say "Hi". My sweet dh has been in the Air Force for almost 10 years now, we have been married for nearly 13 yrs, and have 5 kiddos (3 girls and 2 boys) whom we homeschool. I have been thinking about/reasearching WLS for about 5 yrs now. I have decided that this is going to be my year to try and start the process. I would have liked to try so many times in the last 3 yrs but I have put it off because of fear or intimidation of the PCP's here on base. I have never really been treated with respect in a base clinic except by a OBGYN, or civilian Dr. However, I just need to get over it and move forward. We are PCSing in early March to NE and I am excited for a new start. I have one friend who had WLS years ago and now I am hoping to *meet* some new ones, and learn as much as I can.
Blessings,
~Renee~