Health & Safety

October 18, 2013

Ask the Doc

doctor

Q. Does TRICARE cover weight loss bariatric surgery?

A. Yes, but here are certain conditions that must be met.

TRICARE cost shares on any of the following open or laparoscopic surgical procedures:

1. Roux-en-Y gastric bypass

2. Vertical banded gastroplasty

3. Gastroplasty stomach stapling

4. Adjustable gastric banding i.e., adjustable LAP-BAND®

ONLY when all of the following conditions are met:

  • You’re at least 18 years old or you provide documentation of completion of bone growth.
  • You were unsuccessful with non-surgical medical treatments for obesity. Your medical records must show your failed attempts.
  • Diet programs, such as Weight Watchers®* and Jenny Craig®*, are acceptable methods of dietary management, as long as there’s medical documentation of participation and monthly clinical visits with your doctor.

These programs aren’t covered by TRICARE.

  • Physician-supervised programs made-up of only weight-loss medication management, don’t meet this requirement.
  • You have proof of one of the following:
  • A body mass index greater than or equal to 40 kilograms per meter squared kg/m2; or
  • A body-mass index of 35-39.9 kg/m2 with one clinically significant comorbidity, including but not limited to, cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, Pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy, or pulmonary hypertension.

Send your questions to askthedoc@nellis.af.mil.




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