tricare revision?

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

I don't have any knowledge of tricare but I did have to pay out of pocket for my surgery due to an ins denial.  So what I really want you to know is that ins isn't everything.  It can be done without it and it only makes you value the tool you have that much more

I don't have the money to pay for it, if my insurance denys me im def in trouble. 

This was taken from the tricare provider handbook.  It may be considered medically necessary since you are having problems with the band.  I would talk with your PCP and urge how important this is to you and your health.  If he pushes it then they may approve a revision for you.  What does he say?

 

Good luck

 

Bariatric Surgery

Bariatric surgery for morbid obesity is a covered TRICARE benefit for those who meet the criteria established by TRICARE. Bariatric surgery requires prior authorization.

TRICARE only covers one bariatric surgery per lifetime. In certain medically necessary cir****tances, TRICARE will also cover bariatric-revision surgery.

TRICARE does not cover:

• Nonsurgical treatment of obesity or morbid obesity (e.g., commercial diet programs, weight-loss supplements)
• Redundant skin surgery when performed solely for the purpose of improving appearance
• Biliopancreatic bypass, gastric bubble or balloon, gastric wrapping/open banding or sleeve gastrectomy for the treatment of morbid obesity
• Devices used for bariatric surgery not approved by the U.S. Food and Drug Administration

For more information on surgery for morbid obesity and the criteria, refer to the TRICARE Policy Manual, Chapter 4, Section 13.2.

I have Tricare and they paid. I don't know about  revision though

I have tricare and was banded on 6/19/09 and am currently in process for RNY.  My Surgeon has told me that tricare will do a revision if it is found to be medically necessary.  They told me that since I still have sleep apnea and 4 points away from having diabetes that it is still medically necessary.  So if you still have comorbidities and you did not lose the 50 percent excess body weight with the band then you should still qualify as medically necessary.

I was denied :( so i am going to get together with my surgeon and primary care dr and see what we can get together and do to appeal their decision. im totally bummed out.