tricare revision?

Kennerknecht
on 4/22/14 12:56 pm

I had my lapband done in 09 lost 80 pounds then gained back about 50 pounds and every time i get a fill no matter how much i throw up. so i have a revision request in to tricare for RNY from LAPBAND. did anyone else have this or another revision done with tricare? was it hard to get approval through them? people keep telling me they are going to deny me and its making me sick to my stomach. any stories would be helpful good and bad. 

 

Thank you

Starting Weight - 350             Goal Number One 299
Surgery Weight-  335             Goal Number Two 249
Current Weight-  325             Goal Number Three 199
Goal Weight -      150             Goal Number Four 150
     

    
PHAT_at42
on 4/23/14 10:48 am
DS on 03/12/14

Hi,

I have Tricare Prime and had a VSG to DS on 12MAR14 at MAMC at Ft Lewis Washington. If you find a military facility that perform the procedure you would like to revise to then you go directly through the facility and Tricare is not a factor. You will need to have a consult from your PCM and meet the criteria of their program. When you have a procedure at an military facility the money comes out of the facility's funds not Tricare.  What city/state are you in? Hope this helps! 

 

 m1=23, M2=11, M3=4(had stall for 3wks), M4=6 M5=6 M6=6 M7=4 M8=3

I am a VSG to DS revison!

 

 

Kennerknecht
on 4/23/14 3:07 pm

originally i was at MAMC when they said i could get a revision, however i am no longer than i am in mobile, al. i guess i could go to the naval base in pensacola if i need to. but my currently lap band surgeon is requesting revision because my band makes me wicked sick!

Starting Weight - 350             Goal Number One 299
Surgery Weight-  335             Goal Number Two 249
Current Weight-  325             Goal Number Three 199
Goal Weight -      150             Goal Number Four 150
     

    
PHAT_at42
on 4/24/14 11:30 pm, edited 4/24/14 11:37 pm
DS on 03/12/14

See what they say and if you hit a stop sign then you may need to consider traveling to a MTF for surgery. I live on the east coast and traveled to the west coast (Ft Lewis) in order to have the DS. MAMC is the only military facility, that I am aware of, that peforms the DS. It was well worth it.

 m1=23, M2=11, M3=4(had stall for 3wks), M4=6 M5=6 M6=6 M7=4 M8=3

I am a VSG to DS revison!

 

 

Kennerknecht
on 4/29/14 12:03 pm

I was denied :(. checked though their call line, but dont know the reasoning yet. Once i get my paper i will be figuring thatout. I have a question how did getting your surery at madigan work? did you just flu their for your surgery? i was stationed their prior and have friends up there. I have Keesler AFB and Pensacola Naval near me and am considering traveling to one of them. any insight on that would be great. I am def going to appeal this and get together with my PCM and Surgeon to see if they can team up to help me out as well.

Starting Weight - 350             Goal Number One 299
Surgery Weight-  335             Goal Number Two 249
Current Weight-  325             Goal Number Three 199
Goal Weight -      150             Goal Number Four 150
     

    
PHAT_at42
on 4/30/14 12:59 am
DS on 03/12/14

My PCM placed a consult requesting that I be seen there. I had to go for an appointment at WR(MTF near me) so that they could certify that they do not perform the procedure. Initially I was told that travel was authorized and I paid out of pocket for flight and hotel anticipating reimbursement. Once I returned home and submitted my claim they denied it stating it was not medically necessary nor a tricare covered procedure. I'm OK with that becaues 4months ago I was preparing to travel to CA. and self pay for the DS with Dr. K.  So, I still saved thousands of dollars and had excellent care.

I would recommend you do some homework and find out which military facility near you does bariatric surgery and have you PCM place a consult for you to go there. One tricare approves the consult call the bariatric department and schedule an appointment to meet with a surgeon. All the information and phone # should be available online.

Good luck!

 m1=23, M2=11, M3=4(had stall for 3wks), M4=6 M5=6 M6=6 M7=4 M8=3

I am a VSG to DS revison!

 

 

Kennerknecht
on 4/30/14 11:46 am

Im having trouble figuring out the closest facility that is MTF that performs it. 

Starting Weight - 350             Goal Number One 299
Surgery Weight-  335             Goal Number Two 249
Current Weight-  325             Goal Number Three 199
Goal Weight -      150             Goal Number Four 150
     

    
PHAT_at42
on 5/1/14 1:19 am
DS on 03/12/14

Call Tricare and ask!

 m1=23, M2=11, M3=4(had stall for 3wks), M4=6 M5=6 M6=6 M7=4 M8=3

I am a VSG to DS revison!

 

 

Kennerknecht
on 5/1/14 7:39 am

I called tricare about it today they said i was denied because its is not a medical neccesity. Im going to appeal but im also looking into the MTFs, i asked tricare this morning which bases closest to me performed bariatric surgery her reply? you'll have to call them and see if they do. uhm isnt that your job to tell me which ones? shes like i dont have access to the specific of information -_- so ive been calling around, and i "THINK" Eglin AFB in FL (2 hours form me) does it. so im calling them tomorrow since when i called there was no answer. Im working my butt off to do this, i also called my surgeons office and they had no idea that it was denied and they can't understand why because it is a medical neccesity due to the issues im having from my band. so they are going to talk about it and call me back i guess. 

Starting Weight - 350             Goal Number One 299
Surgery Weight-  335             Goal Number Two 249
Current Weight-  325             Goal Number Three 199
Goal Weight -      150             Goal Number Four 150
     

    
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