Question:
Does anyone have advice on how to get Tricare Prime to pay for TT?

Help. Tricare PI have a friend who has Tri-care Insurance and she was denied the T.T. I have a friend who had WLS in Columbia Missouri, she has lost all the weight that she needs to, and now she wanted to get the tummy tuck, well she has sent in pictures, to the insurance company and they have deined her claim, the reason i am so interested in this is because we have the same insurance company Tri-care Prime (active duty), and I am hoping to have WLS surgery soon. If there is any advice from tricare prime people please help.    — Tina B. (posted on December 13, 2001)

December 13, 2001
i also have Tricare Prime active duty insurance. I am pre-op until 12/26/01. I would talk to your surgeon and see how he/she deals with this situation. A lot of times if they have to preforma a hernia operation at the end of the weightloss then they will dot the t.t. as well. The extra fat and shkin can cause hernia risks and other health risks. So, i suggest to speak to your surgeon and then make sure you go through his office w/ a referral or have him work w/ your PCP to get that referral for you when the time comes. Good Luck.
   — Brandi W.

December 13, 2001
I am also a dependant with Tricare. I am post-op and have asked this question to my tricare post-op buddies. This is what I have 'heard'. To have a TT covered, the apron must be causing some problems, like rashes. They will also do it if you have a hernia, at the same time. I have also heard that 80% is covered. We are responsible for the remaining 20%. I wish I had hard facts for you, this is just what I have been told. Good luck.
   — Cheri M.

December 14, 2001
Hi Tina, me again. I found a really great group and someone there would probably have an answer for you. www.groups.yahoo.com/group/OSSG-military
   — Cheri M.

December 14, 2001
I got approval with TriCare Prime in less than a month, the hold up was actually the surgeon's office submitting the auth request in a timely manner. With a BMI of 48-49, my PCP, (I go to a military facility even though my husband is retired military) was very supportive and open to the "suggestion" of WLS. So, the first hurdle of getting my PCP to provide a medical history was over (this was a request of the surgeon). I then went to the surgeon's office and obtained their application which included a full history of weight loss attempts etc., and THEY actually wrote and sent the letter of medical necessity, NOT my military PCP. Tricare is very specific about their requirements, (look on their website, and it is spelled out clearly.) If you have any more questions, please feel free to e-mail me, I would be most happy to help in any way I can. [email protected] Judy Hardman. BTY, my surgery is scheduled January 29th.
   — JUDY H.

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