Help with DS info- tri care prime

aquapeach
on 7/15/12 6:26 am - Germany
RNY on 03/13/13
Hi! To make this short-  I have tri care prime- hubby is active duty. I have gone through all the steps required- nut-psy eval-upper gi- blah blah blah ( but it is through a surgeon here that is covered by tri care prime  but he doesnt do DS--he  will do the Rny--- and i did ask if he would distally- which he said he would) However- I am so wanting of the DS-- mainly so I can take my nsaids and dont have to have such heavy narcotics for simple headaches. As well as other reasons.  we are pcsing to vilseck germany in october 2012.Anyways- what I am wanting to know is the following:
1) Is DS covered by tri care prime- or tri care prime europe/overseas?
2. if  so -where- or what surgeons ? or facilities in germany?
3. would tri care pay for  the surgery -reguardless of what country i lived in.?
4. my bmi is 43- and I know i will gett approved for wls but is it the same for ds? ive heard many surgeons state that its only reserved for extremely high bmi-s 50 and above.
 yes i have caled tri care and have tried looking it up online - but have recieved conflicting information-
pls someone help-- I am truley set on DS -and am willing to travel- to get it- but I need it to be covered insurance wise. thanks! Any and all info would be greatly appreciated.

Valerie G.
on 7/15/12 6:53 am - Northwest Mountains, GA
 I know that many have had their hearts broken by tri-care prime, so that's the bad news.  They don't cover the DS.  I'm not sure about EU if it's any different.

The silver lining is that there are military surgeons that do the DS, and if you do it at a military hospital, then it's covered.  I know a gal here at Wright Patterson AFB who was just so lucky.  

Valerie
DS 2005

There is room on this earth for all of God's creatures..
next to the mashed potatoes

aquapeach
on 7/15/12 7:04 am - Germany
RNY on 03/13/13
Thanks! Im a bit confused though, by that. So if i call up or find a military surgeon that performs the DS- and that does these surgeries at a military hospital than I dont pay anything out of pocket? 
So- is it charged to tri care or how does that work... sorry if Im a little slow at comprehending all this.
MajorMom
on 7/15/12 7:57 am - VA
That's the way I understand it. If you find a DS surgeon at an MTF you can enroll in their program and get the DS without going through Tricare. The only MTFs that have DS surgeons are Madigan and Wright Patterson. No idea about Europe. Sorry.

--gina
   

5'1" -- HW 195/SW 187/GW 115 July 08/CW 121 Dec 2012
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aquapeach
on 7/15/12 8:34 am - Germany
RNY on 03/13/13
Thanks so much. I am going to look into both!!

Sheila K.
on 7/15/12 8:56 am
 I had my DS st Wright Patterson Air Force base in Dayton, OH. We had TriCare prime and our MTF happened to have 2 surgeons that did the DS. Just within the last few months the MTF decided they are no longer doing any WLS of any kind. All of the weight loss patients are now being seen by Premier Bariatrics at Miami Valley hospital. The ladies that I know that have anything done have had the sleeve and RnY

 



 

aquapeach
on 7/15/12 9:45 am, edited 7/15/12 9:45 am - Germany
RNY on 03/13/13
So being that   the 2 surgeons at Wright Patterson AFB  are not doing the surgeries at the MTF--  and all the wls patients are now being seen by Premeir Bariatrics - does that mean I would contact them- Premier at Miami Valley-- and I would still be covered as if I went to a MTF??(probably not likely-- but oh how i do wi**** were so.. :).. )
 I was so excited when I read that there was a MTF closer than Washinton State- with madigan army medical.... that had surgeons performing ds surgery..   I live in TN- but hubbys is stationed at fort campbell ky (only a few minutes to get to since we are right near the state line)...  so 6 hour car ride would be so much better than a plane ride for 6 hrs!!
oh btw- thank you for the info!!

walter A.
on 7/15/12 11:55 am - lafayette, NJ
Dr Anthone did my ds, and tri care participated in the payment excludeing the ds aspects.  which wasnt a lot of money.
aquapeach
on 7/15/12 12:15 pm - Germany
RNY on 03/13/13
See- thats what I have been wondering-- there has to be some sort of way to get around it. I mean i could pay some-- but not very much. How could i go abt this- do i just ask the surgeon- can you file everything EXCEPT the ds aspects and let me know what i would need to pay??  Thanks in advance!
nightowl
on 7/15/12 3:51 pm - Topeka, KS
Walter had other insurances that did cover the DS parts.  I really think Madigan in Washington is your only way to have it substantially covered for you.
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