Tri-Care and revisions
My daughter is needing a revision from the band and wanting the sleeve done. Tri-Care has indicated they will only cover a Gastric Bypass. Has anyone had success getting a sleeve with Tri-Care? She lives in Ohio if that makes any difference. Thanks for any advice!
Age 66... VSG 12/29/14... H.W. 360... S.W. 323... C.W. 253
Have you looked in the main handbook.. I recall something about that. I know they will not do a DS and I am having a bear of a time trying to cover a revision. Try just googling Tricare and follow the links till you manage to find the handbook. You are not triwest I don't think.. if you are let me know and I think I can find it for you...
I have the band and are revising to the sleeve due to a slight slip, Tricare has approved the removal but not the sleeve. Unfortunately I will have to be self pay in order to get it.
I was also told (and it is written in the bylaws) that they have a one bariatric surgery per lifetime clause, I didn't want the bypass so my surgeon didn't submit for it so I am not sure if they would cover the bypass due to the exception.
They paid for my original band back in '08, that was just when they were starting to pay for it.
Good luck, I would appeal the decision it can't hurt. I don't have that much time to waste, my band needs to come out so it's time to beg, borrow and consider stealing LOL just kidding but it was a thought.
That excuse was given to me as well- One surgery per lifetime. Fine except they didn't pay for the first one! I have been going around and around with Tricare on a approval since 4/16/15. I am so fed up with the excuses, reasons and unreliable information they keep giving me I am ready to scream! I have very valid reasons for a revision and my Surgon agrees. His staff has been trying to get this approval as well. Sigh.. I am keepin on and on... My options without the surgery are two other surgeries, ones that I very very much do not want and are much worse than any side effect from a revision!
