PLASTICS AND TRICARE??????

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.

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 31^st 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.

I know this is an old thread, but if you have ever posted on here you usually get an email. I just wanted to share my story with all of you and give some others(and myself) some hope! I had my RNY in Feb 2009 and lost a total of 175 lbs, leaving me with the tummy apron, wings, thigh flaps and chest flaps.  You all know what I mean! I developed rashes and yeast infections in the warm summer months (Louisiana heat!) in the folds of my skin, and I also had a hard time shaving my legs without nicking them on the lose, thin skin that hung in waves. I worked out my arms as best that I could and they are somewhat ok, but they still hang down. The breasts are my worst disappointment, having gone from a DD cup to about a B realistically, although I use the extra skin to stuff into a modest C cup to make me feel better :). I went to my MTF and to the doctor that referred me to the gastric bypass surgeon and explained to him the problems that I had with the excess skin. He sent out a referral on the 5th of February to a plastic surgeon, one that specialized in reconstructive as well as cosmetic surgery. I think that was the key, and I think my doctor knew it.  He listed the reason for the referral as candidiasis of skin. You can't see all of the clinical details on the beneficiary side of the HUmana website. Anyway, he set me 4 hours away to Houston. I had the first consult this past Wednesday. Dr Berzin felt I could get all of my wanted procedures covered by tricare, and if not, I could pay OOP for thesurgeon's fees of the ones they did not cover and have them all done at the same time so at least Tricare would cover the majority of the hospital costs. Originally I was interested in the Tummy and thigh area and I had no hope of getting a breast lift.  After meeting with the insurance person at the office she was fairly confident she could get all procedures covered by documenting the skin conditions (pruritis, candidiasis, other fungal infecction, friction rashes) and submitting the auth request with the pictures that they took in the office. (I did not have prior documentation with my PCM about the rashes except for the one visit. )  Today the auth was submitted to Tricare and it should take about a week to hear something back. I have heard more than once on forums and Tricare themselves that if they are the ones to approve the bariatric surgery in teh first place and pay for it, you have an easier time of getting plastic surgery approved. I'm keeping my fingers crossed! I hope any of this helps you all and please update your posts to include your results with tricare!

Tricare approved my abdominoplasty, my PCM requested it for me noting skin infections because the sagging skin, ect.  You should always make a request to your PCM that they note ANY skin/medical issues you are having because of the excess, sagging skin. Good Luck!

I did an internet search and found this web site. Just moved to San Antonio where my best girl friend has lived for the last 4 or 5 years. Our husbands are both retired Air Force. She got gastric bypass about 6 years ago,then a tricare approved tummy tuck after going from 235 lbs down to like 110. She paid for her own breast implants and she has some lipo done around her sides etc. She didnt have anything done to her arms of upper thigh lift. Ill have to ask if it was denied or what.I know shes had tons of prob;ems from her gastric bypass. She has developed adhesions internally (??)and is in pain 24/7 and nothing seems to solve it. Also,she was looking great and seemed to be in great shape,now shes regained weight but claims almost never to eat. I have to know-is this possible?? Shes bigger than I am. I am 5'3" and weigh 153-and I tell you guys Im freaking out bc Ive gained about 10 lbs during this move bc of messed up sleep,eating bad,etc. Pluas we moved in July(ourselves!14,000 lbs packed moved and unloaded after movers basically cancelled!)
So anyways Im having a hard time finding time,energy and ideas on how to not only loose weight but I seriously wanna get BUFF. Im so sick of looking like a MOM. LOL. I know it seems weird to some,but Im 33,Im not 83. I feel trapped in my body and btw my feet are in constant PAIN 24/7. I dont wanna go to another foot doc bc I dont want more surgery! I have a neuroma in my left foot I developed after surgery to correct flat feet and a bunch of other bone problems back in 2007. My right foot was just done in March of this year. So all that moving furniture and crap just kills my foot! I just wish I could be pain free. And PS--I weighed 200 lbs then gradually lost weight bc I needed to to help my feet. Mainly the tramadol for my foot pain caused my appetite to diminish. Then almost a yr ago I got on phentermine which I have taken on and off and lost 25 lbs from that . I still havent found an exercise that doesnt kill the feet!! Maybe pilates? I have a pool but even the water rippling sometimes aggravates nerve endings. Sorry for the long post just had to vent!

Okay I know I'm REAAAAALY late on this one, but after reading everyone else's posts-I am curious.
I have tried what I can think of to try and get TriCare (Prime) to pay for a Gastric Bypass...I'm 235 and should be 135. Have had 2 kids, both C-Sections, have the "pannus" (or the fanny pack, as I call it) of fat hanging over my uh...nether regions. I was gestationally diabetic, but I'm not anymore, I have a couple of psych issues that I'm working with a Dr. on, and I have a hernia in my belly button and my C-section scar feels like it's being pulled/pinched or whatnot if it is moved any which way but the way my stomach naturally lays.

I've heard that TriCare pays for a Tummy tucks, but to be honest I would rather go for a Gastric Bypass, since I have tried every kind of diet out there (since I was 10) and have previously and am currently working out with a Personal Trainer. I'm getting stronger, but not losing the weight.

I've had a sleep study done to see if I had sleep apnea (I do, but only in a very mild form-not enough for insurance to do anything about)....so I'm wondering if there is anyway to get TriCare or my PCM to put in a referral for me have GB. I asked one of the doctors at my clinic to put in a referral for me, but he said I had to find a surgeon that would take me first and THEN I would have to come back to him and ask for the referral. So far no luck. It is very depressing because I look like a melted person-and I've even had a tummy tuck consult done by an out in town, out of pocket Dr.-who quoted me $10,000!!

The reason I'm asking is because a couple of the posts said that the people who had received the GB were in or close to my weight range.

I'm 5' 4" 235 and 31 yo female. Thanks for any info....(I'm also scared to ask my doctor for any kind of GB referral or TT referral because I'm afraid that they'll be like "why do you want one?" and I won't know how to answer. Thanks again)

delete message did not realize how old the thread was

hi everyone im new on here..but i have been slightly going through the process of getting tricare to pay for my tummy tuck.. i had to have my galblatter removed when i was 7 months pregnant.. i ended up with toxcemia shortly after and was swollen till 3 weeks after my labor.. well i had extra skin down there even when i was 8 months pregnant.  i constantly get rashes that bleed and it burns and itches really bad.. my first pcm told me he would get it approved he wanted me to loose 35 lbs and be sure i was done having kids.. so here i am i lost 31 lbs and forsure i dont want anymore kids.. and my pcm retired.. my new pcm said that the cheif med doctor would shoot down any plastic request being submitted and refer me to mental health?? i spoke to my tri care lady on base and she told me that we in tricare prime are entitled to a one time evaluation to a general surgeon or plastic that are a network facility not evaluate and treat but evaluate and he or she will then determine if they will submit it for approval he will take picture and usually if the surgeon thinks that its medically needy then it will happen but it is a process.. so im going to start this process and i will update how things are going for me.... she did tell me that if they deney your request to see a surgeon then you need to appeal and go up the chain of command.. or go to patient advoc. office... filing a complaint will get things moving if you really need it and are getting short changed like us at tyndall.. because just because im unhappy with the saggy skin at the bottom of my belly  does not mean i need mental health and its just rude and mean...

They never told me any of that, how weird? They only told me that the codes (insurance billing) needed to match the procedure and be significant enough (higher level codes involving more complications blah blah) to warrant the procedure. I'm thinking that I might have mine completely covered because of the hernia repair along with the extra skin removal. They removed 8 pounds of skin from my abdomen after the hernia repair. 

I had my RNY in March of 2009. I lost approximately 145 pounds and I had a strict exercise regimen that I adhered to. In the end I was left with a lot of extra skin on my abdomen, hips, and thighs. I have Tricare Prime and spent 3 years on a waiting list in Hawaii for a plastics consultation in which they told me it wasn't warranted. I was experiencing fungal infections in the folds and in my belly button, multiple skin tears in multiple sites, as well as a permanent and disfigured indentation from accidentally zipping my skin into my pants so many times (I couldn't feel it when I did it but the skin infections that resulted from it were aweful.) I finally took matters into my own hands and traveled home to MN (there is no active duty medical station here) and was able to see my bariatric surgeon *****commended a plastic surgeon to assist with the extra skin removal. I fought for over a month calling the hospital, tricare, and my surgeon and the only answer Tricare ever gave me was that in certain situations they would cover a panniculectomy, abdominoplasty, breast augmentation, and liposuction. They did, however, refuse to give me the parameters. I had my surgery last Tuesday and we are waiting to see what the insurance says. Before we went into surgery we were doing the abdominoplasty because of the excess skin hindering my ability to properly exercise and the care and upkeep required to keep it dry and skin tear/infection free. However, once I came out of surgery my plastic surgeon informed me that I had a significant umbilical hernia and that is why my stomach had the appearance it had so I am hoping that now because of the hernia they will cover the whole thing and not the portion the surgeon knew they would cover (panniculectomy). I will keep the forum updated if they actually pay for the procedure.