PLASTICS AND TRICARE??????

Chauntelle C.
on 2/26/08 9:40 am - Havelock, NC
Have any of you gotten a referral for plastics that got approved???  I requested a thigh lift, that was deemed medically necessary by my PCM (losing 14 inches in each thigh makes them hard to shave!) I get cuts that get infected on the backs of my legs and I have been told that there is no way tricare will pay for a cosmetic surgery regardless if it is medically necessary.  Im not asking for a tummy tuck or breast implants (I really want them, but I know they are NOT medically necessary!) I just want to be able to shave my legs w/out becoming a contortionist and using a tube of bacitracin!

I was told that there were NO patients that ever got plastic surgery from Tricare and if they did they were defrauding the government!  

If you have had plastics paid for by Tricare I want to hear from you PLEASE!!  IM ON MY KNEES BEGGING!!!!!
Chauntelle Chandler  California City, Ca

                        239/127/125 - 2 pounds from goal!!
cware1970
on 2/26/08 10:13 am - Fort Meade, MD
Chauntelle,   I was just on here last night and I read that someone on here got approved for surgery. I went on the Tricare website and it says that if it is deemd necessary by your PCM then it should be paid for. If they don't approve it the first time I would appeal and have my PCM appeal. Good luck and let us know the outcome. Candie
leann1
on 2/26/08 10:30 am - Panama City, FL
I was just at my plastic surgeons office yesterday. I had breast augmentation in December self pay for this.  I am also tricare and I was asking obout my stomach legs and arms.  They told me that they just had someone approved for their stomach and Tricare paid for it as long as it could be done as outpatient surgery.  I think as long as it is medically neccessary that Tri-care will cover it. My surgeons office even asked if I wanted them to start getting my paperwork ready to be submitted.  I told them no as it will be summer soon and I still have 16 lbs to lose and I want to stabilize over the summer and then have surgery.  I wish you all the best.  Has your PCM doctor submitted the paperwork for a referral to a plastic surgeon yet? Leann 

      
A journey of a thousand miles must start with one step!

Andi190827
on 2/26/08 10:37 am - Fort Leavenworth, KS
Yes, in the policy handbook (it is available online on the tricare website) it says plastics are covered if medically necessary.  I haven't started the plastics route yet (still pretty early post-op) but I've paid attention when I hear tricare and plastics listed together in a post. What I've seen is that Tricare will cover removal of excess if medically necessary. There needs to be documentation of rashes or infections, treatment of rashes and rashes from PCM, etc. They'll only cover a TT if you need a hernia repair along with the removal of the panni. Otherwise they'll only pay for the panni removal. I've seen people get the TT anyways and just pay the surgeon the difference in price.  Tricare does pay for breast reduction, but not augmentation. Of course you'll have to have prove of back pain, rashes, infections, etc. The reduction includes lifting the breast too. So if you have enough to spare, getting a small reduction might be worth it to get the lift.  I haven't seen anyone get athigh lift covered, but doesn't mean they won't cover it. If you do get it approved let us know, I'm looking into a thigh lift as well. Have you checked out the plastic surgery forum? You could ask this there with Tricare listed in the title of your thread. I'm sure you'd get some responses there too. Good luck!
Andi Highest 278 lbs, Pre-op 269 lbs, Goal/Current 150/160 lbs
Currently looking into plastics...

Change the voices in your head... Make them like you instead.

mom of many
on 2/26/08 11:02 am, edited 2/26/08 11:04 am - Moving to Alabama
I have Tricare Prime and got approved for  tummy tuck, That was April 2006...Now mind you, YES it has to be medically necessary or rather, what Tricare deems medically necessary. However, lots of documentation will help. Dr's visits, pictures, etc....I did not have a hernia, nor a panni, just a basic anchor tummy tuck. Sooooooooo, anything is possible. I do know that when I first went to my plastic surgeon he said he didnt think Tricare would cover it because it was not alot of excess tummy skin, however, with the letter of medical necessity they covered it 100% and I paid nothing. Hope that helps! Good Luck MOM

Hugs,
MOM
Open RNY~March 10, 2005 ~
237/121 (116lbs GONE) 
TT April 4, 2006                          
It's a small world after all.....

dmohead
on 10/21/09 8:20 am - Lithonia, GA
REALIZE Band on 02/26/09 with
I have Tricare Prime I'm hoping that I can get approved for the Tummy Tuck. I haven't started the process yet but I'm keeping my fingers crossed.
     http://www.youtube.com/user/blakkandi
           
                
1d_coleman
on 2/2/10 11:46 am
what all did you go thru to get it done? I have had three kids and two c-sections and have lost weight now my tummy is just nasty! would love to have this done please let me know
dmohead
on 2/8/10 4:58 am - Lithonia, GA
REALIZE Band on 02/26/09 with
I am trying to get a tummy tuck. I am waiting for Tricare to respond. I sent in my paperwork on this past Friday
     http://www.youtube.com/user/blakkandi
           
                
jojoweeks
on 9/16/10 7:55 am
Did you have the surgery at a military clinic? I am getting real nervous about getting tricare to cover it. I got the referral to go to a military clinic, but when I called them they said tricare has NEVER paid for a tummy tuck, They said that it doesnt matter what the doctor says, that its just considered cosmetic....Do you have any advice for me, Im almost tempted to not go if its just gonna be a NO. I have to travel 6 hours just for the consultation.so Im worried about it. Any advice would help,
                                                                                                                                                   Thank you.
KimberlyJ
on 2/26/08 11:36 am - WA
Do you live close to a Military Installation with a military hospital?  I'm up in Washington State and live next to Ft. Lewis which is home of Madigan Army Hospital.  I got my Lap RNY there almost a year ago.  I was told that the tummy tuck is almost always done about 14 months post op.  My surgeon was "matter of fact" about it like it was just part of the process.  Tummy tucks are a commen follow up surgery at Madigan.  You might want to try your area Military Hospital.  Good luck! 
jillianD
on 2/26/08 3:53 pm - olympia, WA
Yep, I am at Ft. Lewis too and when I was doing preop the anestheia dr was like ok and we will be seeing you again in a few months for a tummy tuck!  LOL I laughed and said ok!! And why would it be defruading the gov't??  Tricare is insurance just like any other!
Jilly  BR/BL  April 15, 2009!!

Lulu C.
on 5/18/08 11:01 am - Jacksonville, NC
Tricare paid for my tummy tuck but it was done by general surgery not plastic surgery docs and it was done in a naval hosiptal. I'm trying to get my thighs done through tricare also.  Fraud? That is a very strong word. I can easily say I have committed no fraud and Tricare covered my tuck and my gastric bypass.
Chauntelle C.
on 5/19/08 7:17 pm - Havelock, NC
we just got orders back to cherry point!  I am going on wednesday to look into self paying for breast augmentation, i have had my tummy deemed medically necessary by a plastic surgeon, but he was a weirdo and i wont go back to him.  My thighs were deemed med. necessary but i will wait to get back to nc to have it done as there are no surgeons here who take tricare!  WHen i get back to the point i will have to look you up!
Chauntelle Chandler  California City, Ca

                        239/127/125 - 2 pounds from goal!!
Lulu C.
on 5/28/08 10:43 am - Jacksonville, NC

Congrats! Thats awesome! Please let us know about the thigh lift and how it goes!

Thanks!

Robin,aka Lulu

 

Colleen R.
on 8/2/08 12:43 pm - Bel Air, MD
I too am Tricare Prime.  I had my bypass done at Portsmouth Naval Hospital in Virginia (by way of Cherry Point).  I too got a letter from the Plastic surgeon stating a tummy tuck and thigh lift was medically necessary, but just yesterday learned that Tricare denied it.  So now I have to do an appeal. 

You may want to check at Portsmouth Naval, they have a great plastic surgery department and will do surgery if medically necessary.  I'd get your PCM at Cherry Point to refer you to Portsmouth, take the documents that you already have and I'm sure you can get what you need done there.  I know that cosmetics are on a back burner there due to war related patients, but they will do dependants if medically necessary.  (They used to do cosmetics as well for a small fee, but don't have the staff right now to do that) I have even thought of just going back there to have my stuff done as well...was just "trying" to actually use Tricare and avoid the 4 hour road trip.

Colleen
robbins86@aol.com
MonicaK
on 11/14/08 11:17 pm - Washington DC metro, VA
I got approval on the first try for TT with mus. tight, legs and breast lift...I only did the tt..I might go back for the others but damn the pain and issues form all the surgerys I have had I dont want to deal with it...OH I WAS INPAT. in a civ. hosp for 3 days....

If life hands you lemons find a friend with Vodka and have a party!

I love to ride my motorcycle with th wind in my face and I could not have done this without my 
RNY 10/24/05
TT-10/18/07

Tbercini
on 10/21/09 6:54 pm - NC
RNY on 11/10/08 with
what info did u give to get approved for so much so quickly


proximity02
on 7/21/09 12:06 pm - New York, NY
Thread is old but wanted to reply anyway. I got denied by Tri Care Standard when showing almost a year of medical recrods for rashes and back pain and included photos of my large stomach that hung over after losing 100 pounds. They said it was all in my head and I needed a shrink in small terms. I ended up paying cash anyway for the thigh lift, Extended tummy tuck and lipo. I am now trying to get them to reimburse me, new battle ahead. I hate tri-care.
Elizabeth N.
on 7/21/09 1:01 pm - Burlington County, NJ
That's pretty much what happened with me, too. I had hernia repairs that were covered and paid  cash for the reconstructive procedures at the same time.
(deactivated member)
on 1/4/10 7:13 pm - Fort Benning, GA
Yes I am at FT Benning and I just got one I am so excited I have a hernia and rash on my tummy so my Dr is putting in one  for me I went on line and found this on the tricare web site I thought it may answer some of your questions good luck to you all

Reconstructive Surgery

TRICARE covers cosmetic, reconstructive and plastic surgery to improve the physical appearance of a beneficiary only under the following cir****tances:

  • Correction of a birth defect
  • Restoration of a body form following an accidental injury
  • Revision of disfiguring and extensive scars resulting from neoplastic surgery (i.e., surgery that removes a tumor or cyst)
  • Reconstructive breast surgery following a medically necessary mastectomy
  • Reconstructive breast surgery due to a congenital anomaly (birth defect)
  • Penile implants and testicular prostheses for conditions resulting from organic origins or for organic impotency
  • Surgery to correct pectus excavatum
  • Liposuction when medically necessary
  • Panniculectomy (tummy tuck) performed in conjunction with an abdominal or pelvic surgery when medical review determines that the procedure significantly contributes to the safe and effective correction or improvement of bodily function.

To be covered, surgeries must be performed no later than December 31st of the year following the accidental injury or surgical trauma, except in the case of postmastectomy reconstructive breast surgery or cases involving children who may require a growth period.

TRICARE does not cover cosmetic, reconstructive or plastic surgery related to:

  • Dental congenital anomalies
  • Elective correction of minor skin blemishes and marks
  • Breast augmentation
  • Face lifts
  • Reduction mammoplasties (breast reductions), except in the case of significant pain due to large breasts
  • Blepharoplasty (removal of excess skin of the eyelid)
  • Rhinoplasties (nose surgery)
  • Chemical peeling for the treatment of facial wrinkles or acne scars
  • Hair transplants
  • Electrolysis
  • Removal of tattoos
  • Liposuction for body contouring.