tri-care and plastics

just out of curiosity if anyone has tricare and has had or will have their plastics done how far post op do you have to be before you can talk about a referal?

thank you!

Terri

I have Tricare Prime.  Their rule was 18 months after WLS with at least six months weight stabilization.  The will do a TT. 

The tricare policy indicates they will do a panniculectomy if medically necessary.  You can do a search at the Tricare site for the policy or send me a PM with your email address and I will send you the policy.  I have seen some folks who were easily approved and then I have seen others that were not approved. 

Red

I dont know if this will hel*****t.
But i still have  145 pounds to lose but had to have a hysterectomy and the doc got ahold of tricare and after seeing pics they approved a panni because of rashes and smells.
I had 30 pounds removed and it has made a great diffrence even in the way i walk.
Good luck sweetie

I have Tri care. I'm going to Loma Linda (ca) That is where they are sending me. If I do not like or am not comfortable with Dr Gupta then I can choose from the list on Tricares website. I am one year after RNY,and the ref. said I met the criteria. APPROVED. I hae also learned that the doc has to "write it up just right" they might have to be a little creative to meet TriCare's standards.

is the plastic surgeon the one who writes it up?  or your PCM?  i tqlaked to tri-care the other day and was toldi did not have to wait until 18 months out that is all depends on the person and if they have maintained a steady weight for 6 or so months since they will only approve the procedure once so i was told to go ahead and get with my pcm to get a referral to a PS. i will do that after i get back from vacation in april i think.  did you have to go through alot of hoops?

Thank you

The PCM writes the first ref. They have to write it up so TriCare can ok it. The PCM has to note rashes, skin break down etc. My Dr wrote that she noted a rash a Rx meds( TriCare needs to read that) she also put that my weight is stable and I have reached my goal and don't plan on an loosing anymore. She also noted that when I pull on pants on, sometimes my skin tears in the fold.( really my only problem). It is up to PS to agree with PCM finding. So far no hoops. For My RNY, no hoops either. It only took 20 days from the day my doc put in all the paperwork and I had the other test. EASY BREEZY.

Hi Terri,
I have tricare prime and everything i have had done was at the Army hospital and I also worked there before moving to AZ. I had my bypass, my TT, breast augmentation & belt lipectomy done 2  weeks ago there. I flew back to have my breast and belt lipectomy done. My PCM put me in for a consult and then my general surgeon did my TT once I had issues with my hernia breakouts. Once the hernias were repaired the general surgeon done my TT. I went to Plastics and had a consult with the plastic surgeon another consult done thru my PCM. I went to see the plastics dr and away the things worked out. I was placed on a waiting list and i waited for a year but I had nothing but time I worked at that hospital and I was not going anywhere so I could check on my number at all times. I was 18 mo. out when i got my TT, because I had to wait until the hernia all healed up. but if i had not had the issues with the hernias he would have done it at 15mo he told me. So i think it just depends on the surgeon/person. Some of the surgeons there would tell others to wait 18 mo.  I moved from 89 to 1 in a year so i wont complain and no fees out of pocket. I did not even pay for my food on my hospital stay and I stayed for 1 week. So I can not complain. Tricare paid for the entire thing from beginning to end. Now again Iwas seen by drs on a military installation where my family and i received all of our medical care. Now.... let me ask is your spouse active duty? My husband is active duty. Now i do have some friends that husbands are retired and they have had breast reductions, TT and also had their arms done. But again all at the military hospital. Hope this helps,
Kimmee

Hello thank you for the reply. Yes my dh is active duty but we are stationed here in utah and they do not have the large  hospital just a clinic so i have to be referred off base. i am just in the beginning of the process i have to call my pcm today just to seet up a meeting to get the referral so wish me luck and we will see what happens and if tricare will approve even the referral. i guess i am just going one step at a time.  thank you

Terri

I wish you all the luck in the world. Keep me posted.
Kimmee