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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!!
(deactivated member)
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
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
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.
A.Mason
on 6/15/14 12:43 am, edited 6/15/14 12:45 am - Lawton, OK

That's not true. You can get it approved by Tricare as long as your PCM says that it is medically necessary for you to have. 

Most likely you will get a referral to a civilian plastic surgeon to see you, and then they must send the necessary information and paperwork and photos in for the final approval.   

Remember also that you can choose your plastic surgeon as long as they are Tricare approved.  

Do your homework and check out each one in the area go to there offices ask too see their before and after surgery photos before you make your final decision on the doctor get a feel of if you like them or not.

I mean would you go to a Butcher that tells you that I am going to give you the cuts that I want and that's that.

Or too the one who can listen to you and your desired outcome of what you think you want and need.

Then help you to understand your options so that you can make the best decision for you.