Surgical Option for Weight Control Now Covered

For those struggling with weight-related health issues, laparoscopic adjustable gastric banding (lap-band surgery) is now covered by TRICARE for qualified beneficiaries. Eligible beneficiaries identified as morbidly obese with a high risk of developing life-threatening complications are qualified when they have prior authorization for the surgery.

Your physician will decide if the surgery is medically necessary and will coordinate the authorization with TriWest. Authorizations are granted for a specific amount of time and your procedure should be scheduled within the time allowed. Beneficiaries registered at www.triwest.com will instantly receive a QuickAlert e-mail notification when a referral or authorization is processed in their name.

What is morbid obesity?

TRICARE defines "morbid obesity" as meeting one of the following conditions:

1. The body weight is 100 pounds over the listed weight for height and bone structure (according to the most current Metropolitan Life Table) with accompanying severe medical conditions—conditions shown to have higher mortality rates when associated with morbid obesity
2. The body weight is 200 percent or more of listed weight range for height and bone structure (according to the most current Metropolitan Life Table)

In addition, TRICARE will cover the gastric banding surgery if a patient has had an intestinal bypass or other surgery for obesity and, because of complications, requires a second surgery.

TRICARE coverage for the procedure is retroactive to February 1, 2007. Beneficiaries who believe they have had claims for laparoscopic adjustable gastric banding denied after February 1, 2007 can submit a written request that the claims be reprocessed.

You and your doctor will have to decide if surgery is right for you. Living a healthy lifestyle after surgery is just as important as keeping healthy before surgery. Whether dealing with a current weight issue or to help keep your weight from becoming an issue, you can find healthy eating and weight management tips online in TriWest’s Healthy Living Portal.