I need Tricare Prime to approve a tummy tuck

Tamara D.
on 3/3/09 12:50 am - Jacksonville, FL
I was approved for a consult to see Dr Hardy in jacksonville and he suggested a tummy tuck would benefit me but informed me that he didn't think it would be approved by Tricare Prime even though the excess skin causes me problems. I want a second opinion with a surgeon who's experienced with working with my insurance company. Before my RNY, was 260, now I'm 123 and had a baby in Oct. Has anyone with Tricare Prime been approved for a tummy tuck? If so, who was your surgeon? and how did you go about the process? I want to do this without having to appeal, etc. I had no problems getting approved for my RNY.

Tamara

    
Redhaired
on 3/3/09 4:27 am, edited 3/3/09 4:31 am - Mouseville, FL
DS on 07/13/06 with
Tricare will approve the panniculectomy.  But you will have to prove and document medical necessity.  If you have rashes -- do not self treat, you want to be able to prove this is a long standing problem that has not been cured by less invasive treatment.  This is going to mean you will have to see your PCP more than once for a rash.  They will also want pictures to see how far down the panni hangs, as I believe this is also a factor in whether or not they will approve.  The trick is to find a surgeon who will work with Tricare.  I have heard of people who have had plastics at MTF, if you are able to access care there.

You can find a copy of the plastics policy at mytricare.com -- or send me a PM with your email address and I will send it to you.

If you are in N Florida or South Georgia you might try Dr. Bill Mitchell.  I sent him an email once and he answered right away that he did accept Tricare and had worked with them on getting approvals.  My surgeon in Tampa, Dr. Paul Albear also works with Tricare.

Red

ETA:  You might want to post this on the plastics board, as there are several people who post there who have had plastics approved through Tricare.

  

 

 

dmohead
on 1/14/10 9:38 am - Lithonia, GA
REALIZE Band on 02/26/09 with
Thanks for this info. I will pass it on plus I'm lookin to get a tummy tuck in a few months I will get the paperwork started
     http://www.youtube.com/user/blakkandi
           
                
proximity02
on 4/8/09 2:32 am - New York, NY
Good luck they refused me with 6 months of medical documentation, photos, rash cream, etc. I lost 100 pounds and I had a medial thigh lift, lipo and a full tummy tuck yesterday with muscle repair. Paid cash, tricare said it was all in my head. 20 pounds was removed, I am going to try to submit this case to get paid for but I doubt it.
Mala0077
on 6/3/09 7:04 pm
Tricaire paid for my tummy tuck from Dr. James Hardy,  best smart decision I ever made.  Medically it isnt called a tummy tuck it has another name but basically its the same thing.  I had my medical dr. and psychiatrist write letters reflecting how the skin was hanging and causing my depression to worsen.  That is when it was approved and today I am again a size 9 with a tummy flat as a board.    The surgery is very painful and the recovery time is sooooooopainful, but it is worth it in the end.  Good Luck.
dmohead
on 1/14/10 9:41 am - Lithonia, GA
REALIZE Band on 02/26/09 with
I want a tummy tuck so bad
     http://www.youtube.com/user/blakkandi
           
                
dmohead
on 1/14/10 9:45 am - Lithonia, GA
REALIZE Band on 02/26/09 with
hopefully they will approave me
     http://www.youtube.com/user/blakkandi
           
                
cherriemiller01
on 8/14/10 8:58 pm
hi,my name is cherrie i am wondering if you can email me how you got approved for getting a tummy tack my email add is cherriemiller01@hotmail.com    thank you