TRIcare Maddess----PLEEEESE Help

cjedrw
on 7/7/14 5:50 am

I am at the end of my rope.  Air Force Dependent  in Pensacola FL (Eglin) Current Tricare Standard.  I really want the VGS.  I believe that it is the right Choice for me.  My outside doctor has been denied three times with three different patients from Tricare.  Do I have to go to a MTF? If so which one near me will do it, Eglin does not.  TRIcare is being professionally unhelpful. (Literally like it is there job to be this way).  I see a lot of people here have gone through TRIcare.  Why am I getting denied and how to I get this procedure done.  I have already done the 6 months of things you have to go through.  All the boxes are checked.  They just say that VSG is not a covered procedure.

D66
on 7/7/14 8:49 am

Oh my, I'm a Tricare spouse and a newbie. In the early stages of this. How long was it before you were told of being denied? As of yet, I've haven't heard a word but then again hasn't even been five business days yet???

Oxford Comma Hag
on 7/7/14 9:34 am

TRICARE does not cover the VSG. This is directly from TRICARE.mil:

TRICARE will cost share any of the following open or laparoscopic bariatric surgical procedures:

  • Roux-en-Y gastric bypass
  • Vertical banded gastroplasty
  • Gastroplasty (stomach stapling)
  • Adjustable gastric banding (i.e., adjustable LAP-BAND®)

If you want the sleeve, you will have to go to the MTF for it to be paid for. If you are willing to get the band or RnY, you can go to a civilian doctor.

good luck

I fight badgers with spoons.

National Suicide Prevention Lifeline: 800-273-8255

Suicidepreventionlifeline.org

D66
on 7/9/14 2:31 am

Thanks for info on this....I just wonder how long before one hears back from Tri-care. Is it days, weeks, months??

Oxford Comma Hag
on 7/9/14 4:16 am

The processing guidelines are something along the lines of 5-7 business days for routine requests. You can also call and check on the status of any request you doctor has made or sign up on the regional contractor's website and check that way, too.

I fight badgers with spoons.

National Suicide Prevention Lifeline: 800-273-8255

Suicidepreventionlifeline.org

D66
on 7/9/14 4:37 am

Wow, thanks for the info. Where did you acquire such knowledge? You on Tricare as well?

Oxford Comma Hag
on 7/9/14 4:58 am

I worked for one of the regional contractors for years, and I still deal with TRICARE at work. TRICARE.mil is a reliable source of information, and the regional contractors all have some information on their websites.

I fight badgers with spoons.

National Suicide Prevention Lifeline: 800-273-8255

Suicidepreventionlifeline.org

D66
on 7/9/14 5:00 am

Girl, you are great help. Thank you four the info and support. May I send you a friend request? 

Oxford Comma Hag
on 7/9/14 6:49 am

Sure

I fight badgers with spoons.

National Suicide Prevention Lifeline: 800-273-8255

Suicidepreventionlifeline.org

D66
on 7/9/14 7:09 am

I've tried to located you to send friend request. No luck, can you send me one please

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