Has anyone had a RNY revision on Tricare?

tinamarie_125
on 7/15/12 11:37 pm
 My military doctor doesn't want to do a revision, instead he wants to keep doing EGDs.  He says revisions are very risky. This past Friday was my 16th EGD. I have a stricture that won't heal. I don't have an ulcer, I don't drink or smoke. They have no idea why it won't heal. I am looking to get a second opinion but will have to change plans on Tricare to see a civilian doctor. Can someone shed some light on the cost with Tricare? 
Jenn D.
on 7/16/12 3:25 am - CT
RNY on 01/29/13
With Tricare Standard you would have to meet the year deductible (either $1500/$3000) out-of-pocket. And remember the Tricare year is Oct 1- Sep 30
Tricare Retiree- Not sure but I am almost positive that there is somewhat the same thing as Standard going on...
Prime- If it is just your doctor at the MTF, have you considered changing you PCM? Up here we do the peirs system, but I still had to change my PCM on paper for that doc to put in a referral for my surgeon...
No help on the actual revision bit, and I wish you all the best!
Jenn
(deactivated member)
on 7/16/12 4:10 am
Are you still morbidly obese?  If you lost the weight you would not qualify for WLS.  However, they may pay to have it repaired.  The problem is that you will still be prone to strictures because they will have to suture your stoma to your remnant stomach, then perform VSG or DS and the small intestine side of the stoma will have to be reattached or removed.  If you are so prone to scar tissue, this will most likely compound it. 
tinamarie_125
on 7/16/12 7:01 am
 Hi Chris. No, I am not morbidly obese. I am 5'4 and 130 pounds. My military hospital does not do RNY to ds or any other types of revisions. He said the only one that they rarely do is where they would basically redo my gastric bypass. I'm not sure if there is a medical term for that. He described it as having RNY all over again. I saw a civilian WLS doctor about 5 months ago when we were temporarily assigned to the DC area. He immediately said I needed a revision. But I knew we would be moving soon and I wanted to wait and have it done at our new duty station (Portsmouth, va) so that I could be followed by my original surgeon. Little did I know he is not very confident in doing revisions. I really don't know what is best for me at this point. I just know that I am not happy confined to a life of liquids only. I throw up about 90 percent of what I eat. 
As far as changing surgeons at the military hospital....my doctor is the chief of surgery so I doubt another doctor is going to 1. Be more confident in doing a revision and 2. Go against what he suggests. Idk what to do next. I don't think we can afford the co pays and deductible if I go to a civilian.
I wish I had not had WLS. I feel like I could have tried harder and now I am confined to a life of vomiting and possible feeding tube, feeling sick all the time and possible dieing at an early age.
MsBatt
on 7/18/12 11:19 am
This really sucks! Obviously you need medical care that your present doctor isn't capable of giving you. I don't know of any way of convincing Tri-Care to cover what you need, which is an experienced revision surgeon.

Tri-Care HAS covered the DS for a handful of people, but only when done at certain military bases, and I highly doubt those surgeons are experienced in doing revisions. In your position, I think I'd start talking to talking to either Dr. Roslin in NY or Dr. Keshishian in CA about taking me on as a self-pay patient. No, it's not cheap---but isn't your life worth whatever it costs?
SugarGrl
on 7/16/12 9:05 am
Make an appt w/your PCM after getting copies of your doctor's notes calling for a revision. Ask to be referred to a bariatric surgeon. If they won't do it file a complaint with the Med groups patient advocate.

    
  WE ARE ALL IN THIS TOGETHER!  LET'S GET HEALTHY!     STARTING WEIGHT 211.8, SURGERY 23 MAR 11; ONEDERLAND 30 MAR 11 199.2                                                                                                                                                                                                                                                    

Carol S.
on 7/17/12 10:25 pm - Milwaukee, WI
On July 16, 2012 at 4:05 PM Pacific Time, SugarGrl wrote:
Make an appt w/your PCM after getting copies of your doctor's notes calling for a revision. Ask to be referred to a bariatric surgeon. If they won't do it file a complaint with the Med groups patient advocate.
 This.

We need bariatric surgeons to deal with bariatric issues.   
Carol

SW/276 CW 150 GW 185

9 Years out.
            
Jenn D.
on 7/18/12 3:50 am - CT
RNY on 01/29/13
That's all well and good, but not how Tricare works at all.
USAF Wife
on 7/18/12 6:05 am
It all depends on what region you are in.

Some parts of Tricare has added the lovely "once in a lifetime" WLS clause so no matter who you see, they might deny you.

HOWEVER, you have a medical necessity beyond say a band failure with a revision to VSG or RNY.

Tricare Standard is more liberal with doctor choice, BUT you will have to meet the copay, the out of pocket cap, pay for all the co-pays for the diagnostics etc. I believe for an individual (at least here in the South) region, the individual annual is $1,000 out of pocket, for a family it's $3,000.

Revisions are risky, there really isn't anything you revise to except have your RNY taken down and converted to either a VSG sleeved stomach or DS to maintain the malabsorption.

Tricare is NOT covering either of these procedures. VSG is ONLY covered at military hospitals (and you don't want a non-revision surgeon trying to take down a RNY pouch, there's only a handful of experienced surgeons who can perform the take down, much less convert you to a sleeve), or just have your RNY reversed, BUT again you don't want someone who hasn't performed complete takedowns on RNY operating on you. Your surgeon is telling you he can't do it, I'd trust what he's telling you. RNY revisions are extremely complicated. DS is NOT covered at all.


Band to VSG revision: June 3, 2009
SW 270lbs GW 150lbs CW Losing Pregancy Weight Maintenance goal W 125-130lbs


lillypond...
on 7/18/12 12:33 pm
I am so sorry to hear that-- can you get another doctor at Portsmouth to look at you? My doctor is Dr Mann there..  Someone should be able to help you with this problem.. I am so sorry hope you get a answer soon. wow 16 EGD that is a lot.. that is the only thing being tricare you are kind of struck when it comes to having to go to a civilian doctor, you have to pay out of pocket.
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