??? about Tri-Care insurance and TT.

Has anyone had Tri-care Prime pay for a TT???

Annette, First, I am 'pre-op', waiting for TriCare (Standard) to approve or disapprove. Secondly, I had a TT done in 1993, which the military paid for, which I didn't even want! I had a diastis recti and hernia. I had went to a civilian general surgeon. The military wouldn't pay for that, especially since we lived close to many bases. I went to SEVEN different military doctors, all saying to 'live with it' or 'it's not that bad'...I looked like I was 7 month pregnant!! The bottom line, I kept on pluggin along and ended up at Portsmouth Naval hospital because the previous military doctor referred me there...........which was a plastic surgeon.......they were so booked, they just outsourced and I chose a plastic surgeon and had it all take care of..........which ended up with a TT! Moral of this story..........try to go to a base plastic surgeon! It took me a full year and seven doctors, and all I wanted was the hernia repair and diastis recti fixed! Don't give up......go to the doctor's and keep going to another until something gets done!! I hope this helps, but I know my experience was a long time ago...before TriCare...but still......I had military base hospitals available to me, but was outsourced! Perhaps you could change to TriCare Standard? You can pick and choose doctors that way. Just remember, it MUST be deemed 'medical' and NOT cosmetic! I have to wonder if access skin in the abdominal area doesn't affect the internal organs by pulling them down?? Start researching and good Luck Annette!! Could you tell me your experience in getting your WLS approved? Did TriCare ask for any dr. supervised diets? Any information would be greatly appreciated!! Jl

Hi Jl.... Thanks for the info above.  I'm looking at tricare for my plastics, but wanted to chime in here on my experience with Tricare and WLS. Last year, I decided that WLS was the best thing for me to do.  I changed from Tricare Prime to Tricare Standard to avoid being put on the 2 year waiting list at Portsmouth Naval Hospital.  I contacted Tricare to find a doctor that was in network and researched him to see what people had to say.  I selected my doctor who pre-screened me and instantly approved me for surgery.  This prescreening consisted of a review of my medical records, an outline of 3 years weight history and weightloss attempts (nothing had to be supervised), record of comordities, current BMI (over 40 w/ no comordities/over 35 w/ 2 comordities), psy eval and general physical.  Once he reviewed this to ensure that I was healthy enough for the surgery and met Tricare's criteria, I was approved.  Tricare did not do a pre-approval, as they rely on the doctor's prescreening.  The total time it took for me was 6 weeks from date of attending the doctor's seminar to date of surgery. As for dealing with Tricare, it was the best experience I have ever had.  Very easy to deal with. Now, I am hoping that my plastic surgery will be as easy, but, I have a feeling that it will not be.  I've contacted Tricare to find out what I need to do, and they said that my Family Practice Physician has to refer me to a Plastic Surgeon and it has to be of medical necessity.  So, I'm in the process of seeing the physician often to document my lower back pain (which is chronic), and every rash, lesion or red spot under my skin folds (not many to report).   So, hope this information helps you. Jill 263/155/145

Does Tricare always send approved WLS to the naval hospital? I am a new military wife and not quite use to how things are done. I have Tricare Prime.   I just asked called yesterday to my PCM about a referral to see a bariatric doctor.  Still waiting for her to call me back. I meet the 200% requirement with no problems.  From what I read it seems like a very simple approval process with them.   But, I don't want to wait 2 years for a surgery date!  Two years ago I had a horrible denial process with Cigna.  I don't want to go through that again.