Question:
Anyone have tricare and win an appeal for a Panni?
I put in for a panni removal and breast reduction and hernia repair. Tricare approved my breast reduction and hernia repair but denied my tummy tuck. My PCP wrote a nice letter in support of my appeal with medicial documentaion of rashes and other pictures. I will also write a letter along with my Plastic surgeon and my gastric bypass surgern.. Has anyone won there appeal through tricare? What else should I put in the letter besides pictures. TIA — Catherine B (posted on April 1, 2004)
April 1, 2004
Catherine, sorry I do not have any good advice for you. I am still waiting
to hear from Tricare myself about approval for a tummy tuck. I read you
profile and see that we are at the same stage in this journey. However, you
have lost more weight-Great job. Keep me posted about the Tricare stuff
and if you need to appeal the Tummy tuck. I am interested in how your
approval process is going. Good Luck.
— Jan S.
April 1, 2004
Like my WLS, I just bypassed Tricare and went to a military hospital and
talked to a surgeon. My neighbor had her WLS at Ft. Benning,Ga and then her
tummy tuck at Fort Gordon's hospital, Eisenhower, Georgia. Try that route.
Good luck.
— Angela S.
April 2, 2004
I'm a military dependant, too. Not ready for my panni yet, but as I've lost
170 pounds now and still at least another 100 to go, it's become obvious I
need one. Been looking into this for awhile. Just wanted to let you know a
couple of things I've found. For one, being approved or not depends largely
on the health care crunch in your area. They may do it for you or not
depending on how short-staffed the military hospital is. I find it odd
though that they told you you could have the hernia repair but not the
panni. My military surgeon had told me that since having the hernia was
cause for surgery in the first place, they normally always approved doing
the panni at the same time while you're already under! Were they really
considering your case as a whole? Yes, naturally you should appeal, and
appeal and appeal again if you have to. But also make it clear that you're
willing to travel (as far as you viably can) to another facility to have it
done if need be. This may open a lot of doors that hadn't been previously
considered. For instance, in my case, I may not get in here at my hospital,
but can if I drive 2 hours to the next nearest one. Tricare is also more
likely to approve you by going through the military hospital than going
outside, my surgeons told me. Within the system it is considered a lower
priority, but outside the system, it's also more expensive for them! Also
wanted to let you know that I have heard of many people on this site who
HAVE gotten their pannis done both on the first try, and through appeal. So
it's not hopeless! Keep up the fight. Good luck!
— christied
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