TRIcare? New to the board and could use some input (:

Hi there Im looking at revision surgery but Im wondering if I should even bother... I have TriCare for insurance.

Hubby is in the Army, and a problem with Tricare is that like no one ever accepts this government insurance for military families (one would think it should be the opposite) so I dont think I will even find a surgeon never mind getting the procedure approved once I have  a surgeon :/

 

So, anyone on the board have TriCare for insurance or know of someone that does? If so please share your experience with me.

I am in NH and i dont even see any surgeons listed that do revisions...but there are 3 in Massachusetts. I wonder if I could even use my insurance in another state?

 

thanks all :)

Hi I am in MA and have Tricare Prime North. I had my band in 2007 and am seeking a revision to RNY.  I have gone through all of my surgeons requirements and am waiting for approval.  Tricare has a "one bariatric surgery" per lifetime policy but will approve a revision if medically necessary. I spoke to the Nurse Case Manager a few nights ago and she told me that Tricare has really buckled down on revisions and make it tough to get approval.  They need all of your records from your first surgery and you must have met their requirements back then even if you had other health insurance that paid for your first surgery.  If this is something you want then fight for it, as I am.

You can go anywhere with Tricare but need a referral from your primary care physician. I think that may differ in you are near a military medical facility but just ask your primary doc.  He/she is where you need to start.

Best of luck and feel free to private message me or email me for support.

Hi I stared the revision process back in August. i saw the new Dr. for thee revision and had all my testing completed. It showed I have a haitail hernia, staple line disruption and partial obstruction at the band. 

Tricare denied me once. So, the resubmitted it. Denied twice. Then in December they were looking to do a peer to peer and submitted an appeal. They called today to tell me that Tricare is sticking by there original denial.

 

So good luck to you. i am now going back to Dr to ask for a plan B.  I dont know why they cant remove the band or replace thee band and fix the staple line disruption. If its broke it needs fixed.

Please let me know how tings go for you.

Did they give you a reason for denial?

I have TriCare Prime. I had my PCP submit a request for a revision in November. It was approved by Tri Care the foIlowing day. I was told I needed to go to the Pathway intro class and speak to the surgeon afterwards to see what he would have me do since this is a 6 month program for bariatric surgeries. Since I have done all of the classes when I had surgery the  first time much of it was waved for me. Long story short I saw the surgeon last week and am scheduled for a revision on March 19. My surgeon is planning on doing the DS unless thee is too much scarring from the RNY. As of right now almost all of my food is going into my remnant pouch thru a fistula so its as tho I never really had the surgery except that I have the malabsorption still.

Good luck in your search. I know people have actually called and spoken with some of the surgeons from Madigan and traveled here  from all over the US to have their surgery because Madigan does have several surgeons who do the DS. I have had very positive experiences so far.  

good luck with your journey.

Sharon

Well all I can say is The surgeon in St. Louis wanted to do a DS or gasrectomy remove the part of the stomach with the staple lin disruption and the obstructed band area.  I submitted EGD, and upper gi showing i had problems.  They denied me 3 times and now the Dr. said i had to hire a lawyer. i did talk them into letting me come in for a plan B if there is one.  TRICARE said i did not have problems until after 3 years after surgery.  They also said they were sticking by the once in a life time rule.  I dont understand how they cant fix something thats broke. 

Did you get the peer to peer. I don't have the TRIcare you all have but, I took me talking to customer service supervisor and the head of referral who both talked to the head of medical review to get my once in a lifetime over turned for medical reasons. I admit I broke down bawling while I was telling them of my 2.5 years of hell and over three years of issues.  I also had to talk to one or the other every step thru the process to get each step, which would be denied, over turned.  Don't give up Jana, you for sure need the revision for medical reasons.  That has to be fixed and at least the sleeve would fix it if they wouldn't approve the DS.  What difference does it make if it took 3 months or 3 years to go bad?

Jana, is there a local military hospital fairly close to you that  you could be referred to? I think once you start with drs in an actual military hospital you will have much better luck. We have a large hospital here in the northwest at Fort Lewis so all the services are there. They have been wonderful to me. Wish I could give you some advice to help you get the revision y ou need.

Sharon

Sharon, Did you have the original surgery at Madigan? What type of surgery did you have?

I had my original surgery 5 years ago at Madigan by Dr. Carter. He did the RNY and it was so fabulously successful. But over the past year and a half something has happened. I have gained back half of my weight lost and I am thinking of asking for the DS.

Your insights would be helpful.

Thanks! Fran

Hi Fran,

I had my original surgery done at St Clair by Dr. Nyreen. I had an RNY and of course ended up with the fistula. When I decided to have a revision they referred me out to Madigan. Because I am a revision I didn't have to go thru all the hoops. I am amazed how once you get in all the Drs in the surgical dept work together to help you with what you need. I went in to discuss surgery for a hernia and walked out with an appointment for surgery on March 19th with Dr. Carter. He came in to see me that very day and talked with me for about 1/2 hour and told me he would do a revision to the DS from the RNY. The only thing that would prevent that would be too much scar tissue. He mentioned how he felt the DS is a much better surgery than the RNY and how he wished he had been doing them all along instead of the RNY because of the long term success rate of the DS. I had a friend who had the Ds revision last year from the RNY by Dr Martin and has had great success with her surgery.

I would call Dr. Carter and talk to him since you were a patient of his and see what he says. I have noticed several people from different areas of the US have come to Madigan to have their surgeries.

Good luck and if I can help you in any way please let me know.

Sharon