TriCare

TriCare will not approve the DS this season. I have recieved a top level denial, ( which I will share with anyone who is persue a 2nd level or higher appeal),  My appeal was over sighted by the Undersecretary of defense MajGen Granger Md. for TriCare Management. on request of my congressmen, Hon Scott Garrett.  It took them 9months to decide that they dont care what medicare does, ( they specificily said so.they have different standards) or the rest of the government programs.  Or the fact that I am a disabled war vet  whose disabilaty and need for wls is directly related to and cause for of my obesity, and the fact that I cannot have the alternative surgery that they prefer, the RNY, or band.  They address the cost share issues while ignoring the cost of my anual care. for meds alone over 8k,  for what is now 6 co morbids.  I am retired disabled at 60percent for 38 years, and now petitioniing for 100percent as they refuse the surgery that offers a cure.   

I am so sorry to hear about TriCare's refusing to cover your surgery.  After all you have been through with the service, it only seems right that they agree with your surgeon as to what type of WLS is best for you.   I hope you get your 100% disability approved, but I know that will take alot of prayers.  It won't make up for you getting your health back, though. Take care, Linda

Try it again and show them the medicare decision.  They cover it and they're federal.  Tri care should cover iwas well.

the specificly made mention of the medicare decision, and how they did not follow that decision, and why, basicly they have different criteria, I will send you the appeal decision gary if you like, it is from the very top of tricare.

Nope, not gonna happen, at least not in the near future. I got my word just last week, too. The LapBand and the DS are noncovered items, just like chiropractic care, nutritional counseling and a wealth of other useful things. (Although, please don't misunderstand: I'm not by any means placing chiropractic care in the same healthcare league as the DS. I'm just using it as an example of "non covered procedures."  Fortunately, my surgeon and the hospital he uses are very accomodating in helping self pay patients. The surgeon will get a fair amount more than he would get from most insurance companies, but still far from a large sum, and the hospital will be operating at a deficit. I doubt the assistant and the anesthesiologist/s will get enough to cover their malpractice insurance premiums for the amount of time they will be caring for me. God bless them.

{{{{{hugs}}}} I am so sorry. I'm in the self-pay line now because of TriCare's stupidity  (blowing a kiss to my departed dad, may he RIP, for leaving his kids nest eggs).  You have fought a very admirable fight. I haven't posted to you before that I recall, but I have followed your story via your profile and links.  It truly is sheer idiocy on TriCare's part IMNSHO. Just one of my medications costs them over 40K per year. That's one of sixteen that I take daily. Then there's the oxygen supplies, the urgent care meds, and let's not even start with the doctor visits! Fortunately no hospital visits thus far except for surgery. It should be a simple cost-benefit analysis, as in: Patients with xyz comorbidities would stand to gain greater benefit from DS than other procedures. But nope, heaven forbid they should make sense.  *sigh* Is self pay an option for you at all?

hi,     right now Aetna has decided to approve the DS, so I can have surgery, except that I have lost too much weight for any wls, per dr Pomp. my bmi is 33, , the standard differs from that, and my cardiologist urges me to have surgery,  and so do my Pcp, and edocrist, both at cornell. Contrary to DR Pomp.  but DR Pomp is the expert about the DS, not they, and the DS is my only choice.  I am hard to argue with this panel, I wish I could get them in a room.  My need are very very unique,  my condition diabetes insipudus is extreamly rare, and it causes the Afib, that can surely be relieved by the weight loss from the DS, significanly a will the diabetes 2. and the severe apneia. But the DS is researved for the higher weight bmi and I am light weight,  dehydration is major concern.   I would hold off on self pay, I would expect Tricare to follow suit, again, they did the DS until I applied on 4/15/2005, and will probly again, now that Im out of the picture, hehehe.  seriously,  if  Aetna who has 50%  of the private market share caved in tricare is hard put. not to also. 

OH MAN. You came in just *after* the code change, I bet, with TriCare. What a blow.  Congratulations on your impressive weight loss, but yeah, with your comorbidities, it still makes sense to me to go forward with surgery. You are a really unique case indeed with diabetes insipidus.  I have read that in some European countries the DS is being done without the partial gastrectomy for mildly to moderately overweight people with the comorbidities. Might this be an option?