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Tricare now covers lap-band surgery

Seriously overweight Tricare patients have a new surgical option available to them: Tricare now pays for what is commonly known as “lap-band” surgery, in which surgeons place a hollow band around the stomach at its upper end, limiting the amount of food that can be eaten.

Although the Tricare policy change was announced just recently, the coverage is retroactive to Feb. 1, 2007. Patients who received the surgery since then can submit a claim for reimbursement, a Tricare spokesman said.

Tricare officials stress that laparoscopic adjustable gastric banding surgery is only for morbidly obese patients — those more than 100 pounds over the ideal weight for their height and bone structure, and whose weight is associated with severe medical conditions known to have higher mortality rates.

Tricare will also cover the surgery if a patient has had an intestinal bypass or other surgery for obesity and requires a second surgery because of complications.

“We at Tricare are careful to only cover procedures that have been proven safe and effective, and are accepted by the medical community,” said Army Maj. Gen. Elder Granger, deputy director of the Tricare Management Activity, in an announcement of the policy change. “We’ve added this procedure because, for some beneficiaries, it may be the right course of action to preserve their health.”

The band, which can be tightened or loosened over time, creates a small pouch and narrow passage into the larger remaining part of the stomach. The procedure is reversible and does not require the stomach to be cut, stapled or opened, so there is less risk of infection, although there are possible side effects.