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New TRICARE Policy Adds Weight-Loss Options
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A recent change in TRICARE policy now provides coverage for laparoscopic adjustable gastric banding (Lap-Band® surgery), opening new avenues of treatment for those fighting morbid obesity. This policy change is retroactive to Feb. 1, 2007. If you’ve had Lap-Band surgery since Feb. 1, 2007, and qualify under the new policy guidelines outlined below, you may submit a claim for reimbursement or, if you submitted a claim and it was denied, you may appeal the denial.
Lap-Band surgery is a minimally invasive procedure that can help you shed excess body weight. The Lap-Band shrinks your stomach and restricts how much food you can eat at one time.
You are eligible for Lap-Band surgery if you meet any one of the following conditions:
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You are 100 pounds over the ideal weight for height and bone structure and have one of these associated medical conditions:
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Diabetes mellitus
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Hypertension
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Cholecystitis
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Narcolepsy
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Pickwickian syndrome (or other severe respiratory disease)
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Hypothalamic disorder
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Severe arthritis of the weight-bearing joints
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You are 200 percent or more of the ideal weight for height and bone structure. An associated medical condition is not required for this category.
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You have had an intestinal bypass or other surgery for obesity and, because of complications, require a second surgery (a takedown).
For more information about Lap-Band surgery, talk to your doctor about the benefits and risks of the procedure.
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