Anyone have breast reduction with Tricare Prime?

Hi...

Had RNY back in 1/2010 and will eventually pursue some plastic surgery to repair my saggy body... but not expecting that I'll be able to get any insurance coverage for that. 

However, I've always had large breast and I still am wearing a 36DDD... and that's being 165 pounds and wearing a size 8/medium (I'm 5'9").  Since losing weight, it seems even harder to hold my chest up... and since I have arthritic vertebral changes in my lower back as well as some disc issues, my lower back doesn't flex enough to be able to pull my shoulders back enough to hold my chest up.

Long story short, my doctor a couple years back made a comment in my record that breast reduction could be in the future for me, but I haven't specifically talked to a doctor about it since my RNY.  Has anyone out there been successful getting a breast reduction paid for through Tricare?  What was required as documentation? What issues did you have to have in order for them to approve surgery?

Any thoughts would be appreciated... thanks.


tori 

I think the best bet is to go back to your PCP and talk to him. I did a search on Tricare under covered services but I didn't see anything for breast reductions. But if it's medically necessary and considered proven then they should cover it.

Hey there, I had breast reduction surgery through Tricare Prime back in June 2008. My primary sent in the referral and Tricare approved it. I guess your Primary HAS to say it is medically necessary and state those conditions that you stated on your blog. They didn't even question it. Only thing was they didnt approve for the Surgeon that my PCP requested. They said he wasnt in the network. But they will let you know what percentage they will pay if you go to an out of network surgeon. Tricare paid for my RNY in June of this year. Good Luck!                                     sharon

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