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Does TRICARE cover weight loss surgery?
Verified by TRICARE.com Editorial Team
Updated 2024-12-01
AI-assisted (gemini)
Quick Answer
TRICARE covers bariatric surgery when medically necessary. Criteria include BMI requirements, documented weight loss attempts, and comorbidities.
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Key Takeaways
- Covered if medically necessary
- BMI and comorbidity requirements
- Prior authorization required
- Comprehensive program needed
Detailed Answer
Weight loss surgery is covered with specific criteria.
Eligibility Criteria
- BMI 40 or higher, OR
- BMI 35+ with comorbidities
- Failed weight loss attempts
- Psychological evaluation
- Nutrition counseling
Covered Procedures
- Gastric bypass
- Gastric sleeve
- Lap-band surgery
- Revision surgery (some)
Requirements
- Prior authorization
- Approved surgeon
- Comprehensive program
- Documentation required
What's Included
- Pre-surgical evaluation
- Surgery and hospital stay
- Post-surgical follow-up
- Nutrition counseling
- Psychological support
Cost
- Standard cost shares apply
- May be significant
- Counts toward cap
- Network preferred
Related Questions
What preventive care does TRICARE cover?
TRICARE covers annual physicals, immunizations, cancer screenings, well-child visits, and other preventive services at no cost with network providers.
What services require prior authorization?
Prior authorization is needed for many inpatient stays, some surgeries, specialty services, DME, and certain high-cost procedures regardless of plan.
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