Tricare No Longer Covering DS?

I just saw something on duodenalswitch.com message board about changes in what Tricare will approve. According to what I read there, Tricare will know longer approve the DS because they consider it experimental. I do not know what is what. I know that I have just requested my letter of referral from my pcp and have started trying to get my appointment for my psych eval and such. This is such a blow -- words cannot express. I consider myself a strong person but I really feel like crying at this point. I could understand giving us some notice-- saying as of Oct 1- that is the start of the new fiscal year. But this --. Please keep your fingers crossed for all of folks connected to the military-- I just do not think I can live with the RNY and self pay is not an option.

Work on getting everything done and submitted. Then you will find out. You won't know the answer till you have the written denial in your hands. Do every appeal and fight every battle. The insurance companies do this because they WANT you to give up. There are quite a few companies who deny until the first or second appeal. You may at some point decide to get a lawyer too. For now, remember to document everything and insist your insurance company send written notifications!

Thank you for your encouragement. But right now I really think I inconsolable. I may have to wait and see which way the wind is blowing on this one. The surgeon is in Ohio and my out of pocket is 20% plus travel -- that is a lot of expense only to find it is for nothing. Plus it was the out of pocket that kept me from doing this back in January, and they were approving the surgery then. At this point I am so upset and confused I do not know what I am going to do. I have yet to discuss it with DH.

Just curious---why do you have to go all the way from FL to OH in order to see a DS surgeon? I know there are DS surgeons in GA, LA, TN, and I believe even in FL.

Ohio is the closest Doc that accepts my insurance! I should say the closest experienced doc, there is a doc in Florida but he has only performed something like twenty of the procedures.

I know kinda where you are comming from it is hard to go through all of this when you dont know for sure. I will be out of pocket about 1,000 before I will get my final aprovement. I am also traveling out of state. But I am trying to not get to nervous about the money spent but I keep thinking of the bills I could have paid LOL . But try to fight it they want you to just give up. I have not found it yet but there has to be some info on the internet about this not being expermintal.

Yes, Donna, I know the truth is out there. I spoke to my DH and he told me to keep working toward approval. Gotta love that man of mine.

Hi Red, I am so sorry to hear that Tri-care is being so STUPID...AGAIN! But, they're a lot like the military, they don't answer to anyone...Ugh...My husband was in the Army and we had Tricare Prime...and they can change things WITHOUT a moments notice...Just because they want to...Ugh! It makes me so mad. Okay, here's what I learned (the hard way) in working with them...First of all, IF you're having a hard time getting an appointment...Your PCP can refer you out...and you can see a civilian doctor...That's what I did for my psych evaluation...(the psych was tooooo booked so I just got a referral). They don't tell you this...But, there are a lot of doctors in the civilian world that will accept you. Also, YOU NEED TO TELL YOUR DOCTOR TO WRITE IT IN HIS CHARTS THAT HE/SHE FEELS IT BEST THAT YOU HAVE THE DUODENAL SWITCH. Also, they shoud cover the DS...There might not be any surgeons that do it where you are...But IF you can find one and your PCP refers you out and SAYS that it's in your BEST interest to have the DS...I don't see why they would deny it. When I FIRST started my WLS journey in 2003...they were saying the the RNY was experimental...BUT they were still covering it. I will keep you in my thoughts and prayers and hope that every thing works out...It will...Just have faith. Hugs and Prayers, ~Darcy

Thank you for the encouragement Darcy. My husband is retired and it is a little different -- there is no military treatment facility involved. Tricare has been covering both the DS and the RNY for years and this is very sudden. But, since having gotten some sleep I have decided to take a step back, gather my wits and to design a plan of attack. I may not be as well schooled in insurance and Tricare policy as I would like but I am certainly going to try to find a way around or through this. Thank you to everyone for taking the time to respond to my little fit of despair.

i feel like i just had a GOLDEN SHOWER! ALL OVER MY PERADE. well the navy gave me this disability 37 years ago. and in spite of thier predictions i'm still kickin, and now i want tri care to finally ante up a claim because aetna (who has been footing the bills all these years) is so anti ds, they back down, and i cannot have a rny, or banding. DID U VOTE FOR BUSH, HE IS CUTTING VETERANS BENEFIT DEEPLY, HE HAS CUT THE FEDERAL MONIES TO THE STATE FOR VETERANS (NURSEING) HOMES, AFTER SEEING MY DOCTOR EVERY 3 MONTHS FOR THE LAST 5 YEARS, NOW IT OK TO SEE HIM EVERY 6, BECAUSE OF CUTBACKS, MAKES ONE THINK TWICE ABOUT TELLING ONE OFFSPRING ABOUT THE HONOR AND REWARDS OF THE MILITARY,