tri care prime breast reduction, panni removal

does any one know what is covered un tri care? i have tri care prime south...i am 1 year post op, lost 110 pounds but the girls are still a 42DD left side and right side is DDD....

just starting to think about this...
thanks
debby

I have Tricare South as well and I was able to get them to put the referral to plastics.  After the 1st appointment to plastics was submitted I was denied a breast lift (DR. labeled it as breast lift rather than reduction)  but was approved for the "panni".  The Dr. told me if I wanted full TT and breast reduction  i was going to need to pay out of pocket 8000. I was only able to come up with the money for the full TT but could not pay for lift.  Later I found out Tricare did in fact pay the full balance. My Dr.  was pissed.  I was able to have the money reimbursed.  The rate they get paid for the surgery versus what they were charging  me is huge difference.  Be careful in how they word referral.  If you check on the website it indicate "panni" is done in conjunction with muscle repair (Full TT).  They are bound by the contracts signed with Tricare. My breasts I have yet to finance.  If the breasts were done that day it would have only cost me 3500. After I got my money back they wanted me to pay over 6000.  UHHH NO!!!  So I am still trying to figure out how to get that done. I think if they had labeled surgery as reduction rather than lift it would have been covered but Dr. did not want to do "reduction" ....  Yeah cause they know Tricare does not cover lift ....  I will be interested to find those who have recently had their breasts done so I can get some pointers as these girls need some serious help but I am not going to be "scammed" by Dr. again.

I have Tricare prime as well. I didn't try for breast coverage but they did cover the Panni. I paid an extra $2300 for lipo, muscle repair and body contouring. I'm going to have to take a closer look at my referral closer to see what it says about muscle repair being included in the Panni approval. Interesting! I'm only 2 days out but very happy with my result so far. So even if I don't get anything back, it's still money well spent.

thanks ladies, i was told they cover the reduction and lift if it is medically neccessary..back pain, rashes, posture, etc...which i will start to document...i will also document the rashes under my belly..i have mentioned it from time to time....but will get more diligent about it...

so they cover a panni removal with muscle repair, but they wont cover a tummy tuck??? arent those the same things?
thanks again for your help, like i said, i am just starting to think along these lines..but the girls NEED some help, they are so heavy and just plain hurt most of the time....just did not loose much with the girls at all...
have a great day
debby

On Tricare's website it lists it as Panni removal (Tummy Tuck) in parenthesis....  Its a matter of what Tricare believes they are paying for which is the tummy tuck and the Dr.'s interpetation of what panni removal includes. I am very happy with getting the full tummy tuck for sure and if I didn't get the money back it still would have been worth it...  Its all a matter on how they code it. Good Luck!!!

We have a plastic surgeon here on base.  The Tricare referral office called me to set up my appointment.  My consult is on June 13th.  My girls are completely deflated and my stomach skin is awful!  The rashes are terrible.  I have had to alter my lifestyle to keep them away.  I loved to walk outside but I live in Florida and it is hot!  This is prime conditions for rashes!  We will see what happens.  I wish you all luck with Tricare!  Happy Military Spouses Appreciation Day!

Meg