Tricare coverage for VSG

Go to http://www.bethesda.med.navy.mil/ and type "bariatric" in the search box. Walter Reed and Bethesda have a joint program - it's quite new, and they're still working out the details. ONLY Tricare Prime patients are accepted. Not VA patients.

The bariatric center at the Navy hospital in Norfolk has done VSG procedures in the past, but you need to give them a call - the only doc that did it was deployed last I checked.

Sheri

Sheri...thank you so much!  You just saved me so much computer time tonight :) Judy
 

IAMHOPEFUL-Have you called your local MTF to see if they perform WLS?
If they do, you may want to get the surgeons name and email him, ask him if performs the VSG.

Again, I want to state that my TRICARE rep would NOT approve me for the VSG, she even called the medical director at TMA and they stated "VSG is not an approved surgery"


I have emailed her one more time and included this (the new CPTcode for 2010) insurance code-
43775 Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)

I will keep you updated on my answers.

Here is the response from my TriCare rep as of today-
"The CTP codes that can be covered by TRICARE are at the top of the policy - 43775 is not included and I had double checked with TMA, our higher headquarters, to see if any change had gotten the response of NO - sleeve still not covered. Sorry."

She also included the TRICare service manual policy (printed 1/22/2010)
If any one is interested in this I will be happy to email it you.

In it it states that the "vertical banded gatrectomy" ( lap band) is covered. I believe some people are confusing the Vertical Sleeve gastrectomy with this!

I am proceding with the RNY. best of luck to everyone.

.
     

As of today, Tricare is still not covering the VSG.  I know this is several months after the factof the original post but for those that do a google on it as I did, they might appreciate the current information as well. 

As of right now, you can only get the VSG at a MTF.  The following is the letter I received from TriWest when I inquired.

Date/Time Submitted:	9/15/2010 9:15:22 AM
Date/Time Responded:	9/15/2010 10:46:26 AM
Question/Concern about:	pamela tallant
Question/Concern: I am in the process of approval for weight loss surgery and have heard many conflicting answers as far as a certain procedure. Your website does not clarify nor does the tricare.mil specifically address the one that I want. My question is, do you cover vertical sleeve gastrectomy, cpt 43775, by an in network physician not associated with a MTF?
Response: Dear Pamela Tallant, Thank you for your recent web mail inquiry. Our records indicate the procedural code 43775, for the lap sleeve gastrectomy, is not a TRICARE covered benefit. If you require additional assistance with this issue, please call TriWest toll free at 1-888-TriWest (874-9378). TriWest Customer Service Department

Because of this, I will probably be opting for the RnY as well.  Good luck to all!

One thing that everyone related to the military in any way knows is that THINGS CHANGE, and they change constantly. 

MTF's will do the VSG, if they have that particular surgery in their program.  Each MTF is different.  It depends on lots of things.  And the policies change every 6 months or so, based on rotation of surgeons, schedules, deployments, etc.

Tri-Care makes changes to their policies all the time.  Keep checking, and calling, and get your surgeons to write them a letter asking for an exception to policy.  If a civilain surgeon says it is a BETTER choice for the patient, they take that into consideration.  Have them add in that there are less follow up visits than for the band, that saves them (Tri-care) money.  If your surgeon has his/her own stats to show that the sleeve would be BEST for you, have them send it in with the request for exception.

Anything can happen!  And watch for those changes! 

Hi!! I am trying to get  the gastric sleeve done at a military treatment facility ,since I have a referral but the civilian doctor will not cover this using tricare prime.. I am located in Dallas Fort worth my spouse is active duty, I keep getting sent from here to there given different answers...numbers to call.. just trying to see if anyone has had this procedure done at a mtf in Texas and how you went about getting it  done when you lived further out I know from another forum there are those that have gotten it done and they lived at least 2 hours from the MTF if not more but Kileen apparently denied seeing me and so I am just trying to get some help please. Any directionor helpful info would be appreciated.

Have you been able to get the VSG surgery done? I was banded in 2008 and am ready to get it removed and wanted VSG instead. I am from Texas, Killeen actually but am currently overseas (England) with my active duty spouse. Was wanting to see if you were able to get the surgery done and where. If I can visit my family in Texas and have my revision done at a MTF while I'm down there that'd be great! 

Hi . I am looking for a surgeon in South Cali that takes Tricare Prime. Anyone used or know of a good one in this area. Living on base it is hard to find out who is out there the website for Tricarewest is not very helpful...wht is that spec. of the Dr. that dose this kinda of work.

Thanks in advance.

Afawna Johnson