TriCare Question on Plastics

Question for the military people on the board.   Tomorrow I go to see my PCM to talk about a referral for my excess skin removal on my tummy.  Who has done this in the Norfolk area?  Do they usually refer to a doc at Portsmouth or do we get to go out on the economy for it?  What are the rules up here?  I just moved from the South region and I knew how to get things done there, but apparently things happen a bit differently in the North region.   Any advice is GREATLY appreciated!!!  I'm nervous about this because I really haven't had any problems with rashes, etc to date.  I really don't want this to be denied.... Thanks!!

I havent gone through it at Norfolk but here at Ft Eustis Mcdonald Army hospital it has been a NIGHTMARE!!!! I have had two c sections done with the same incision, my children are almost 6 and 9 and my scar still opens on me frequently. It has been discovered by two doctors that my excess skin around my tummy has kept my incision from healing properly and it will never heal properly untill it is removed. I was referred to plastic surgery at portsmouth over two years ago and the referrel was REFUSED! I cant explain to you how many doctors and managment officals and patient reps I have been through trying to get some help for this situation. My husband almost lost rank flipping out on an Ahole physicain that had me in tears giving me a guilt trip about how backed up plastics is because of wounded soldiers and such. Long story short I was told at my oreigntation for gastric bypass that if I already have a referral in the system to see plastics about a tummy tuck then I shouldnt have a problem getting one once Im about 18 months post op...but I havent gone in yet for my pre op stuff and Im not getting my hopes up because if I have learned ANYTHING from dealing with tri care in this area ( plastics) it's that it doesnt matter what your told or even if you have a logical reason for needing it...untill your on the table...you have no real idea of what's going to happen if anything is going to happen... Good luck

Wow!!  I'm so sorry you've had such a horrible time.  It sure is different up here than in the South Region.  Down there, if they couldn't see you in-house within a specified length of time, you were automatically referred to a doctor out in town.  Guess I'll be playing with a whole new set of rules.   I hope you are eventually able to get seen about this!  Sooner than later!!!

I do not see where you indicate if you are triCare Prime or Standard.  But, here's what I went through...... I am Tricare Standard.  My physician sent the referral to TriCare who sent it to Portsmouth.  Portsmouth has the 1st opportunity to say yes or no.  Because I am Standard they passed me to the outside.  If I had been Prime they would have seen me. If I had been Prime they would have made the determination that it was elective surgery and put me on their 18 month waiting list.  But, because a Standard they referred me out. They will only approve the TT (and that's on a case by case basis) so because I had a LBL they approved nothing and I had to pay out of pocket. But, I know someone here who just got a TT approved and is trying to sort out if they will apply that to the LBL.  For me, they would not. Good luck!  They ARE a pain to deal with on this issue.

Thanks for replying!! Sorry I didn't add that I'm on Prime.  Sounds like it's going to be a nightmare trying to get the surgery done.  An 18 month waiting list you say?  Dang....I'm tempted to change my insurance to Standard just to have this done and then change back to Prime afterwards....   Oh well....  Thanks for letting me know your story!!

Hi Susan I am not military nor do I have your insurance, but I have had a tummy tuck and I just wanted to wish you all the best with this journey.  Good luck to you and best wishes your way! hugs

Thanks Judy!!!  I appreciate it!!

Hi Susan, from what i've been told with tricare prime and plastics, is that if it's elective they will still do it at portsmouth, but i believe the waiting list is 18 to 24 months and you do pay out of pocket, but right now from what i've been told they are short handed with drs and they are not taking on any new patients. I'm still only 2 months post op put i know eventually i will need a tummy tuck, good luck and let us know what your dr says... Missy 260/202/130 high/now/goal

Thanks for the info Missy!!  I'll keep you posted on what I find out!!

First of all CONGRATS on a new phase of your WLS journey. I have TriCare Prime and have had plastics done in the civilian sector as well as at Portsmouth.  I had been told by many people that TriCare would not cover plastics so I didn't even try to put in for approval.  Not smart because I have since learned that with my 300 + pound weight loss they may have covered it.......I paid cash out of pocket in the civilian sector for BL BA and arm lift.   When it came time for my TT---I was mainly concerned in finding a plastic surgeon  that would do the TT with anchor cut.  I had consults with several civilian docs and then went to Portsmouth Plastics and saw Dr Robert Hersh.  He was FANTASTIC! I paid less than half of their normal fee because they thought I had a hernia. (turned out it wasn't...but wasn't charged any more)  IF you have a hernia---you will not be charged for surgical suite and anthesiologist--which saves alot.  I had an enormous ammount of excess skin due to such a large weight loss so I wasn't expecting perfection.  I was AMAZED at my initial results----you coulda bounced a quarter off my new belly.   I don't know anything about the wait list right now---you might want to check out their program so you know if it is right for you.  HIGHLY suggest that you try and see Dr Hersh.   Look forward to reading updates on your Plastics journey. God Bless~~~