Madigan Army Medical Center?

Thanks Dena for all your knowledge- It sure helps to hear it from someone who has been there, done that! Tricia- sounds like you might want to reconsider the lapband now that they will be covery it? My other primary insurance (Blue Cross/Blue Shield) is also adding LapBand to their list in 2007 but the only place they have chosen to cover is Virginia Mason because it meets their requirements for their Blue Distinction Centers but it says others are being considered. I'm hoping Franciscan is one of those since both Oh and Srikanth are in their perferred providers. I'm wondering though if I should push my appointment from 12/22 into 2007 or if by the time they contact the insurance for the surgical approval it will be already be 2007? It's my hope that BC/BS will cover the majority and Tricare will pick up the rest. Then if BC/BS denies me I can go the Madigan route. Stacey

HI EVERYONE!!! I had open roux-en-y on August 9th at Swedish Ballard with Dr. Weber in Seattle. I am a Navy Wife, tricare covered my whole $66,000 surgeries! Bremerton Naval Hospital offers an AWESOME program, they take you through step by step, so when you go in to see your surgeon for the first time you have EVERYTHING he needs and can submit your forms to tricare and within 1 or 2 weeks you will have a surgery date. Ask your PCP for a refferal to LT CDR Taylor at BNH. The process was really easy and usually takes between 3-8 months depending on how on top of things you are. Dr. Weber is an amazing surgeon. He offers monthly seminars that will answer any queston you may have. I had complications and required a second surgery. Dr Weber knew immediately what the problem was, test confirmed it of course, and I was under the knife within the hour. He has a wonderful manner, I recommend him to everyone who asks about the surgery. His success rates and mortality rates are amazing. He has his own sit at: http://overcomingobesity.com Check into him. Because of the limited choice of Naval facilities performing the surgery, tricare allows us to search the area for a surgeon who may better suit us... and Dr. Weber is very efficent. He doesnt charge you anything other than what tricare will pay. He is driven. I asked him why he chose this line of work... his response is what sold me. He said that over weight people are the most discriminated group of people in the united states, and he loves being able to help them and change their lives for the better. He is a wonderful man, even offering to do some of the skin removal proceedures himself, to save tricare patients from the disappointment of not being able to find a plastic surgeon who will accept tricare. I hope I helped! If you have any questions, feel free to ask! XOXO Sara

Sara, I've heard wonderful things about Dr. Weber. I'm glad you had such a skilled surgeon taking care of you. How are you feeling? Dena

Stacey, I just read what you posted about BCBS Fehb. I did the research for Virginia Mason, and THEY only do RNY. So, I presume that the preferred Docs on the list for lapband should be approved. At any rate, I will be contacting them after the first to make sure my chosen doctor will be covered. I am also covered by Tricare Standard, and there WAS a change that came out on 8/30/06 to INCLUDE lapbanding. It is titled "TRANSMITTAL #: 95 DATE:08/30/2006 TRICARE CHANGE #: C-42/43 2-29.15-1 CHAMPVA POLICY MANUAL CHAPTER: 2 SECTION: 29.15 TITLE: SURGERY FOR MORBID OBESITY AUTHORITY: 38 CFR 17.270(a) and 17.272(a)(22) RELATED AUTHORITY: 32 CFR 199.4(e)(15)" and it states: III. DESCRIPTIONS A. Morbid obesity is defined as a body weight 100 pounds over ideal weight for height and bone structure. B. Bariatric surgery. Surgery for morbid obesity produces weight loss by either limiting the amount of food the stomach can hold (a restrictive procedure), or by creating a small pouch and bypassing part of the small intestine to limit the food hat is absorbed by the body (a gastric bypass). IV. POLICY A. CHAMPVA benefits for surgery for morbid obesity is limited to: 1. VBG (Vertical Banded Gastroplasty) or gastric stapling, without gastric bypass, (CPT 43842) this is an open procedure 2. Gastric restrictive procedure, without gastric bypass, other than vertical banded gastroplasty 3. Gastric restrictive procedure, with gastric bypass; with short limb (less than 150-cm) Roux-en-Y gastrojejunostomy (CPT 43644 laproscopic, or CPT 43846 open approach) TRANSMITTAL #: 95 DATE:08/30/2006 TRICARE CHANGE #: C-42/43 2-29.15-2 4. Adjustable silicone gastric banding (CPT 43843) using the FDA (Food and Drug Administration) approved LAP-BAND® Adjustable Gastric Banding (open or laparoscopic procedure); for severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised studies, exercise and behavior modification programs. The LAP-BAND system is contraindicated in patients with any of the medical conditions listed under Policy Considerations as well as patients under 18 years of age. It is in adobe format. I believe you can get a look at it if you google it. Otherwise, feel free to contact me, and I can e-mail you a copy as an attachment. Cathy H.

I'd much rather have the lap band if they're planning on doing it in 2007. My Dr's Apt for my consult is tomorrow. Do I go in saying I know you're planning on covering Lap band and I want it lol! How do you know when for sure it's going to be covered? I simply want the lap band because it's seems to be a lot safer. I just feel more comfortable having someone put something in me that can be taken out then having someone remove my stomach. So I guess how do I found out when it will be available?

Tricia, I'd let them know that you would much rather have the Lap Band and see what they say. It can't hurt to ask. If it's going to take longer than you were hoping for, they might just approve you to go off base. Who knows? When I originally called Tricare, I was told that I HAD to go to Madigan if I wanted it done, since they perform the surgery there and it's within a certain distance from the base we are stationed at. But, I do know that other military spouses have been able to go off post for their surgeries and have had it covered. However, I want to say that it is because they don't have a hospital on their base/post that does WLS. I live 5 miles from Madigan, so that's why I'm in a sense "forced" to go there. I'm perfectly fine with it. Also, in case you're going by the Madigan website...it's WAY outdated. They no longer remove the larger portion of the stomach. They used to. They also used to only do it open. Even if you are planning on having the Lap Band, I'm sure you'll still have to do the Pathway (the classes that are required.) I personally think it's awesome that they make you take these classes. If you read enough of the posts on here, you'll be amazed at how many people that are completely clueless about what to expect afterwards...i.e. diet, hormone changes, emotions. At least at Madigan you HAVE to take classes so you are much better informed on how to deal with it all. Let me know how it goes! Dena

I went to a support group meeting yesterday and a lady there used to work for TriCare and stated I would have to have the surgery on base to qualify but then I stopped by Dr. Oh's office since I know they have a pile of paperwork for me to fill out prior to my appointment on 12/22 and also to try and get some answers. The gal there was great and actually scheduled me for the EGD test 1/10 and a follow up 1/22 and I haven't even seen the Dr. yet. I posed the question regarding both BC/BS and Tricare covering LapBand as of 07 and whether I should move back my appointment and she didn't think it would be necessary. She also stated that she knows that Tricare has referred other patients to Dr. Oh for surgery in the past. I also know there is an area about Insurance on the forum (I think it's this site). People state who their insurance provider is, the type of surgery, their Dr., approval or denial, and the time frame to get approval. It is listed by the provider and there are plenty of TriCare patients who had already received approval for their LapBand and some very quickly. It seems like it all depends on who you talk to! It just seems silly to push anyone into $66,000 worth of surgery for a bypass when the Lapband is safer and less expensive with fewer expensive complications in the long run!

Stacey, I too have Federal Blue Cross and they don't have a preapproval. You have to have your surgery then submit for approval taking the change they may not cover the surgery. I had surgery on Oct 3rd and still don't have my approval finished. They are now reviewing all my documents the drs office sent them. Part of is was the office hadn't sent in the paperwork for about 6 weeks after my surgery. I wish you the best of luck.

Just wondering how it went with your TriCare adventure is coming along? I have a consultation with them on 1/12/07. I went ahead with my appointment with Dr. Oh 12/22 and have the EGD scope scheduled 1/10 and a follow up 1/22. The gal in the office called today to schedule my surgery! She said she's checked with BC/BS and they will cover it in 2007. I asked if that meant I was definitely approved but no, they still don't preapprove. You have surgery and maybe they will pay. That's scary! Of course she has no experience with their post-approval of the LapBand since they are just starting to cover it but has had good luck with them covering the bypass.