Is this covered??

Hi! Im relatively new here and was wondering if anyone knows if Tri Care Prime will pay for DS surgery?  Thanks

They do not cover the DS when done by a civilian facility.  If you can get a surgeon at a military treatment facility to agree to give you a DS, then yes.  Right now, the only military treatment facility that we see people getting a DS at is Madigan in Washington state.  I know of people who have travelled across the country to get a DS there.  The main surgeon doing it there has the last name Martin.  He is listed on dsfacts.com.  Other patients have said that there is/are one or a few more doctors there that will do the DS also.  There may have been a gap in availability during the surgeon's deployment, but I kind of think they are back.  The contact information for them is on dsfacts.com.  It will take a potential patient who is pretty independent and who has done research of her/his own to make it there, unlike the easier, more widely-available weight loss surgeries they can get nearby from civilians.

Thank you so much for that info. I think I would really benefit best from the DS , but my only source of coverage for wls is the Tri Care prime. I see listings under surgeons that do it nearby- in Nashville and Murfreesboro...we are stationed at Fort Campbell-- live off post and my referal is for a surgeon here in Clarksville. Nashville is only abt 45 minutes away though.. Is there a possibility that I could get another referal to see one of them-- a surgeon in Nashville that does the DS. Im sorry if you just answered that same questions.. its alot to take in when first starting on this journey and what hoops one has to get through. I do appreciate your reply.. Thanks!
(am new to army life as well) .. which leads me to this thought.. when you say Military Treatment facility-- is that just like a hospital on post? I do know the hospital on Ft Campbell does have a bariatrics unit...

I'm sorry to say, I think you have no chance of getting Tricare to pay for your DS with doctors Houston, Spaw, or Boyce, since they don't work specifically at a military-run hospital.

You may be able to get a referral to one of the places that does the DS, but, even if the doctor would accept Tricare, Tricare would only cover your WLS there if you pick one of the surgeries Tricare allows there (which I think are the band, RNY gastric bypass, and sleeve).  Tricare won't cover your DS as a regular hospital, only one that is military-run. Yes, I think military treatment facility means one on post.  If you could convince a surgeon at Ft. Campbell to give you a DS, then the military would pay for it for you. BUT, it would be pretty risky, because they probably do not have much DS experience, if we haven't heard of anyone getting a  DS from them. The DS is exceptionally hard to do/takes a great deal of skill by the surgeon.  The travel would be a huge hassle, but it would be safer for you to get it at Madigan.  Or, is there a chance you could get a job of your own with coverage of the DS from a different insurance?  If so, you could stay in-state.  I know the chances of that may be slim, but I thought I should mention it as a possibility.

MajorMom might be along shortly to comment.  If not, you could PM her or start a new question with her name in the title so she sees it.  She knows the military policies.  I am just going on what I have read online, I have never dealt with Tricare myself.

Well once again, thank you so  much for th info provided, I do  see what you are saying abt it all. Thanks again.. its late and Im finallyy getting tired,,. have a great weekend!! :)

I just wanted to wish you good luck in your search. Your best bet is to get in the Madigan program if you want the DS. There are a couple of folks that traveled from their home station to get in their program. If you want there contact info, let me know.

Also, I love your avatar. I had a wonderful cat that looked just like that. I miss her.

--gina

Thanks for the info.  That would be great if you had their contact info. I really have no "out of pocket money" and  so having tri care prime- I wish I could get it covered.. seems like its giant hassle. though--- but I guess if it was easy as 1'2'3- then everybody would be getting it huh?

Here's Tina's profile here. I'll let her know on email you'd like to talk to her.  www.obesityhelp.com/member/1blessed4life/

--gina

Hi! I was just wondering if you knew of a way for me to contact or get into the Madigan program. Im not sure who I would call or how to do it online. Im all done with all my requirements( at least for Dr steely-- but he would be doing a rny distally-- He doesnt do DS- but nonethe less- all the requirements and meetings have been completed- am just waiting on a date-- but I still would rather the DS... so i hope that helps to move me up on the chain - in getting into the program at Madigan- but also-- Im assuming all expenses to get there as well as stay there for the 2 weeks afterwards are all on me- out of pocket- yes??  is this so.. ? Where would i stay  during the 2 weeks after surgery-  would i just look in the classifieds for a place to rent or a hotel for that amnt of time?-- im just trying to get all info needed. ahead of time.. so i know the damage on funds.. - Thanks in advance.

Did you try to contact Tina through her profile? --g