How To Get Tricare To Cover Weight Loss Surgery?

ByCarla Denker Blog

How To Get Tricare To Cover Weight Loss Surgery?

If you’re a member of Tricare, you may be wondering if you can get coverage for weight loss surgery. The answer is: it depends. Tricare does cover weight loss surgery in some cases, but there are a number of factors that determine whether or not your surgery will be approved.

In this article, we’ll discuss the criteria that Tricare uses to determine coverage for weight loss surgery. We’ll also provide tips on how to increase your chances of getting approved for surgery.

So if you’re considering weight loss surgery, keep reading to learn more about how Tricare can help you.

Step Task Notes
1 Meet with your primary care provider Your provider will need to complete a referral for weight loss surgery.
2 Get approval from Tricare Tricare will review your request and determine if you are eligible for coverage.
3 Find a weight loss surgery provider Tricare has a list of approved weight loss surgery providers.
4 Have your surgery Once you have found a provider, you can schedule your surgery.

What is Tricare?

Tricare is a health insurance program for active duty service members, their families, and retired service members. It is a managed care program, which means that it contracts with private health care providers to provide care to its members. Tricare offers a variety of health care plans, each with its own set of benefits.

Who is eligible for Tricare?

Active duty service members and their families are eligible for Tricare Prime. This is the most comprehensive Tricare plan and offers the widest range of benefits. Retired service members and their families are eligible for Tricare Standard or Tricare Extra. These plans offer fewer benefits than Tricare Prime, but they are also less expensive.

How to Get Tricare to Cover Weight Loss Surgery?

Weight loss surgery is a major surgery that can be expensive. If you are a Tricare member, you may be wondering if Tricare will cover the cost of weight loss surgery. The answer to this question depends on a number of factors, including:

  • Your Tricare plan
  • Your weight and BMI
  • Your medical history
  • Your need for weight loss surgery

If you are considering weight loss surgery, you should talk to your doctor about whether Tricare will cover the cost. Your doctor can help you determine if you are a good candidate for weight loss surgery and can also help you with the paperwork you need to submit to Tricare.

Tricare is a valuable health insurance program for active duty service members, their families, and retired service members. It offers a variety of health care plans, each with its own set of benefits. If you are a Tricare member and are considering weight loss surgery, you should talk to your doctor about whether Tricare will cover the cost.

What weight loss surgeries are covered by Tricare?

Tricare covers a variety of weight loss surgeries, including:

  • Gastric bypass surgery
  • Gastric sleeve surgery
  • Lap band surgery
  • Adjustable gastric band surgery
  • Sleeve gastrectomy

These surgeries are all designed to help you lose weight by reducing the size of your stomach. This makes it easier to feel full after eating less food, which can lead to weight loss.

Tricare also covers some of the costs associated with weight loss surgery, such as:

  • Hospital fees
  • Surgeon fees
  • Anesthesia fees
  • Medications
  • Lab tests
  • Nutritional counseling

However, Tricare does not cover all of the costs associated with weight loss surgery. You may be responsible for some of the costs, such as:

  • Co-payments
  • Deductibles
  • Non-covered expenses

It is important to talk to your Tricare provider before you have weight loss surgery to find out what costs are covered and what you will be responsible for.

How to apply for Tricare coverage for weight loss surgery

To apply for Tricare coverage for weight loss surgery, you will need to:

1. Get a referral from your primary care provider.
2. Complete a pre-authorization form.
3. Meet with a bariatric surgeon.
4. Have a consultation with a dietitian.
5. Get approval from Tricare.

Once you have approval from Tricare, you can schedule your weight loss surgery.

Here are some tips to help you get approved for Tricare coverage for weight loss surgery:

  • Make sure you meet the eligibility requirements.
  • Get a referral from your primary care provider.
  • Complete the pre-authorization form correctly.
  • Have a consultation with a bariatric surgeon.
  • Get approval from Tricare.

If you have any questions about Tricare coverage for weight loss surgery, you can contact your Tricare provider.

Weight loss surgery can be a life-changing decision. If you are considering weight loss surgery, it is important to talk to your doctor to see if Tricare coverage is available.

How To Get Tricare To Cover Weight Loss Surgery?

Question 1: What are the requirements for Tricare to cover weight loss surgery?

  • You must be a member of Tricare Prime or Tricare Select.
  • You must have a BMI of 40 or higher, or a BMI of 35 or higher with at least one obesity-related condition.
  • You must have tried and failed to lose weight through diet and exercise.
  • You must have a doctor’s referral for weight loss surgery.
  • You must be willing to follow a strict diet and exercise plan after surgery.

Question 2: What types of weight loss surgery does Tricare cover?

Tricare covers the following types of weight loss surgery:

  • Gastric bypass surgery
  • Gastric sleeve surgery
  • Laparoscopic adjustable gastric banding
  • Roux-en-Y gastric bypass surgery

Question 3: How much does Tricare cover for weight loss surgery?

Tricare covers up to 80% of the cost of weight loss surgery. The out-of-pocket cost for surgery can range from $5,000 to $20,000.

Question 4: What is the approval process for weight loss surgery?

The approval process for weight loss surgery can vary depending on your Tricare plan. In general, you will need to submit a request to your primary care provider. Your primary care provider will then refer you to a bariatric surgeon. The bariatric surgeon will evaluate your eligibility for surgery and submit a request to Tricare for approval.

Question 5: What are the benefits of weight loss surgery?

Weight loss surgery can have a number of benefits, including:

  • Weight loss: Weight loss surgery can help you lose a significant amount of weight and keep it off.
  • Improved health: Weight loss surgery can improve your health by reducing your risk of obesity-related conditions such as heart disease, stroke, type 2 diabetes, and high blood pressure.
  • Improved quality of life: Weight loss surgery can improve your quality of life by reducing your pain, improving your mobility, and increasing your energy levels.

Question 6: What are the risks of weight loss surgery?

Weight loss surgery is a major surgery and there are some risks associated with it, including:

  • Blood clots: Blood clots can form in the legs after surgery. These clots can travel to the lungs and cause a life-threatening condition called pulmonary embolism.
  • Infection: Infection can occur at the incision site or in the organs that were operated on.
  • Bleeding: Bleeding can occur during or after surgery.
  • Gastrointestinal problems: Weight loss surgery can cause problems with digestion, such as heartburn, nausea, and vomiting.
  • Malnutrition: Weight loss surgery can increase your risk of malnutrition.

Question 7: What should I consider before getting weight loss surgery?

Weight loss surgery is a major decision and there are a number of things you should consider before getting the surgery, including:

  • Your health: You should be in good overall health before getting weight loss surgery.
  • Your weight loss goals: You should have realistic expectations about how much weight you will lose after surgery.
  • Your lifestyle: You should be willing to make changes to your lifestyle after surgery, such as eating a healthy diet and exercising regularly.
  • The risks and benefits of surgery: You should understand the risks and benefits of weight loss surgery before making a decision.

Question 8: Where can I find more information about weight loss surgery?

There are a number of resources available to you if you are considering weight loss surgery. You can find more information about weight loss surgery from the following sources:

  • Your doctor: Your doctor can provide you with information about weight loss surgery and whether it is right for you.
  • The National Institutes of Health: The National Institutes of Health (NIH) has a website with information about weight loss surgery. You can find the website at https://www.nih.gov/health-information/weight-loss-surgery.
  • The American Society for Metabolic and Bariatric Surgery: The American Society for Metabolic and Bariatric Surgery (ASMBS) is a professional organization that provides information about weight loss surgery. You can find the ASMBS website at https://www.asbmbs.org.

Question 9: What are some tips for getting approved for weight loss surgery?

getting Tricare to cover weight loss surgery is a complex process, but it is possible if you meet the eligibility requirements and can provide the necessary documentation. The most important thing is to be persistent and work closely with your doctor and Tricare case manager. With careful planning and preparation, you can achieve your weight loss goals and get the coverage you need to make it happen.

Here are some key takeaways to remember:

  • Tricare covers weight loss surgery for certain conditions, such as obesity, type 2 diabetes, and hypertension.
  • The cost of weight loss surgery is typically high, but Tricare can help cover some or all of the costs.
  • To get Tricare to cover weight loss surgery, you must meet the eligibility requirements and provide the necessary documentation.
  • The most important thing is to be persistent and work closely with your doctor and Tricare case manager.

If you are considering weight loss surgery, be sure to talk to your doctor about Tricare coverage. With careful planning and preparation, you can achieve your weight loss goals and get the coverage you need to make it happen.

Author Profile

Carla Denker
Carla Denker
Carla Denker first opened Plastica Store in June of 1996 in Silverlake, Los Angeles and closed in West Hollywood on December 1, 2017. PLASTICA was a boutique filled with unique items from around the world as well as products by local designers, all hand picked by Carla. Although some of the merchandise was literally plastic, we featured items made out of any number of different materials.

Prior to the engaging profile in west3rdstreet.com, the innovative trajectory of Carla Denker and PlasticaStore.com had already captured the attention of prominent publications, each one spotlighting the unique allure and creative vision of the boutique. The acclaim goes back to features in Daily Candy in 2013, TimeOut Los Angeles in 2012, and stretched globally with Allure Korea in 2011. Esteemed columns in LA Times in 2010 and thoughtful pieces in Sunset Magazine in 2009 highlighted the boutique’s distinctive character, while Domino Magazine in 2008 celebrated its design-forward ethos. This press recognition dates back to the earliest days of Plastica, with citations going back as far as 1997, each telling a part of the Plastica story.

After an illustrious run, Plastica transitioned from the tangible to the intangible. While our physical presence concluded in December 2017, our essence endures. Plastica Store has been reborn as a digital haven, continuing to serve a community of discerning thinkers and seekers. Our new mission transcends physical boundaries to embrace a world that is increasingly seeking knowledge and depth.

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