Tricare Coverage for Bariatric Surgery

Tricare is the health care program arm of the Department of Defense covering active duty and retired military along with certain family members. As with most insurance companies, Tricare appreciates the value of bariatric surgery in patients that will benefit from improvement in the myriad obesity related conditions. However, as with all insurance coverage, Tricare has very specific guidance and criteria for the coverage of surgical weight loss.

What procedures does Tricare cover?

Tricare covers several bariatric procedures, including gastric bypass, gastric sleeve, gastric band, and duodenal switch. They do not cover the gastric balloon, or any procedures considered experimental. Which procedure is best for you will be discussed during consultation with one of our bariatric surgeons after a full medical history and pre-op testing.

Criteria for Bariatric Surgery Coverage with Tricare

Tricare requires several conditions to be met prior to coverage. Patients must:

• Be 18 years of age or older
• Have a track record of failed nonsurgical attempts at weight loss which can include physician supervised weight loss or commercial diet programs. However, if the latter is used as proof of qualification, patients must have monthly clinical visits with their doctor and clinical documentation of their progress
• As is standard, patients must have a body mass index of 35 or over with one or more significant comorbidities. Patients with a body mass index of over 40, regardless of comorbidities, may also qualify. Typical comorbidities include heart disease, type 2 diabetes, sleep apnea, high blood pressure, and more

Of Note for Active-duty Service Members

Because of the significant gastrointestinal and nutritional changes required for success after bariatric surgery, having the procedure may require separation from the armed forces. This lifestyle change, while often critically important to continued health and longevity, may represent a liability in certain military situations. It is important that active-duty service members speak to appropriate administrative personnel to ensure they understand the consequences, if any, of their decision to have bariatric surgery.

Next steps

We look forward to helping active duty and retired service members improve their health through what is often a life changing procedure. We look forward to speaking with you about your candidacy for bariatric surgery and understanding how your Tricare policy may help cover the costs of the procedure. For more information, please watch our online seminar, call our office, and schedule a consultation with one of our bariatric surgeons.