Tricare prime and vertical sleeve

I have had complications with my band and had it "corrected" but am having serious problems again,(acid reflux, nightly episodes of choking and fluid coming out of my nose)gross I know. I have tricare prime, my primary care physician sent a referral to tricare,  there are two military medical facilities in my area that do weight loss surgery, but they did not have the capacity to see me so tricare sent me out to a private surgeon. I am certain that the doc will agree to take the band out but I want to see about getting a conversion to VSG, only problem is Tricare prime does not cover that surgery, but they do VSG at the military facitily but they didn't send me there.  I don't want to have two surgeries, i would like to get it all done at one time, band out and vsg in.  I am recently married so I just got on board with tricare prime so any of you that have experience with tricare can offer some insight or suggestions I would really appreciate it.

Thank you!!!!

I have tricare prime, and am seeking a revision from VBG (which tricare covered????Don't ask me why they would cover a surgery that has such a HIGH failure rate, but they do?) to DS, which is the sleeve plus bypass to the Duodenal Switch. I am having it done at a military facility as tricare does not cover the DS either.

I would call both military facilities near  you and see why they cannot see you??? I would also have your pcp submit another referral to both facilities and try again. That is the only way you are going to get the surgery you want, that, or wait until Tricare gets on board and decides to cover the RIGHT surgeries so they do not have to pay for revisions!!! Seems simple to me, but somehow they just do not get it.

I would just not give up. Call the facilities and get in touch with the bariatric departments and see why you have been denied access, and what you can do to get in!

I wish you the best of luck!!! Just do not give up on the surgery you want. You DO NOT want a third one!

GOOD LUCK!!!!

I also have Tricare Prime and was looking to have a revision, I developed an ulcer to my original RYN, do you know if they cover Revisions? 

When I was at the doctor yesterday the first thing I asked when he said convert to bypass was can I do the sleeve and he said no because there will probably be way to much damage from taking the band off due to adherence.  He says the lap band doesnt adhere as bad as my band but it still does.  My best friend had her Molina band removed at the end of May and converted to RNY and there was no way to go to the sleeve due to the damage.  Maybe yours will not be so bad since it hasn't been on that long.  Mine as been 6 yrs and my friends had been 15 yrs.  I know I didn't answer your question about the insurance but I did want to let you know that can't always go to the sleeve from the band.
angie

Hi Angie, what you say is interesting, cause when I was told the band had to come out, my surgeon suggested the sleeve and said the RNY would be difficult to perform due to all the adhesions; just the opposite of what your surgeon told you (had my band 5 years).  I was going to get the band removed and the sleeve done at the same time, but when the surgeon got in there, the scar tissue was too much and he advised I should wait 6 months to allow the stomach to heal.

After 6 years with the band, I'm sure there'll be a ton of scar tissue, but an experienced revision surgeon can work through this, and again, there's always the option of waiting for your stomach to heal before pursuing a revision.  If possible, I would shop around for someone who's capable of performing the surgery you want.

I also have tricare prime and I am having my revision surgery on Monday, August 3rd. I am converting to the sleeve, but my surgery is being done at Walter Reed. I would keep getting the PCM referral until they have room for you. Or keep calling the medical facilities to see about getting put on a waiting list (if they have one, Fort Bragg did).

Hello all, I actually work for Tricare Prime... have you all tried calling your BSR (beneficiary service representative)?  They should be able to tell you what all is covered and not covered.  Also you may want to get the book for Tricare Prime Beneficiaries as well as visit the website... the telephone number is 800-444-5445... the number may be different depending on what region and state you actually live in... hope this helps. :-)