Tricare-Military Health Insurance & Skin Removal

tinamarie68
on 8/9/07 9:41 pm - cincinnati, OH
I have been researching whether or not Tricare will pay for plastics. The official answer is:

Cosmetic, Plastic,

or Reconstructive

Surgery

Only covered when used to restore function, correct a serious birth defect, restore

body form after a serious injury, improve appearance of a severe disfigurement, or

after a medically necessary mastectomy. ANYONE had any luck with them removing skin after  gastrich bypass????

Deidre V.
on 8/9/07 9:45 pm - Havelock, NC
I have heard several different answers on this...I had a panniculectomy/hernia repair in March, the only thing Tricare paid for was the hernia repair...so, I self paid for the skin removal on my tummy.  Luckily, I was going to be in the hospital anyway...so the cost was only 1000.  If you have documentation of rashes, etc you may be able to get it covered.  Good luck! Dede

308 start weight on 7/18/06
258 50 pounds GONE on 9/26/06
208 next goal 100 gone (done on 3/1)
190 dr goal
150 goal weight
135 current

RJOLLY1967
on 8/10/07 2:54 am - KY
hi there I have Tricare Prim I had no prob with it at all I was approved in 2 days when the paper work got sent in ,good luck

B J 
    
 

redjett
on 8/11/07 11:11 am
what did you have done ?  did they pay for a panni or a TT ?  i also have tricare prime and am hopeing they will pay for a TT.  did you get your arms done ? and please tell me how you worded it so they allowed it.  thanks
RJOLLY1967
on 8/11/07 11:18 am, edited 8/11/07 11:19 am - KY
I had a TT done and mucles tightened on top no I did not have arms done thank God I did not need that I went to gym alot & lifted weights & that helped alot ,I went to see my PCM & told her I had rashes & it was hard to go to the  Gym& work out  because my tummy jiggled to much I know it sounds crazy but it was hard joging with that extra skin on so she sent it in & it iwas easy ,was approved in 2 days good luck need anything else just email me [email protected] I have a pic on my site check it out

B J 
    
 

usmc_honey
on 8/12/07 2:59 am - Oceanside, CA
Do you know what paperwork was sent in?  Did you submit a letter with the original request?  How much documentation was included?  Any information, copies of letters, anything that you are willing to share would be EXTREMELY helpful.  My doc will be submitting AGAIN on Tuesday. Thank you - Andrea
RJOLLY1967
on 8/12/07 3:29 am - KY
I did nothing I went to my PCM & she took care of everything tell your pcm you are having rashes they know how to word it good luck

B J 
    
 

adelida1
on 8/10/07 6:04 am - New Orleans, LA
Diedra, I would submit the bill to tricare for it also becasue not 30 minutes ago i printed the guidelines off the internet and they state they cover it here is the link to the reconstructive section of the tricare website. http://www.tricare.mil/mybenefit/jsp/Medical/IsItCovered.do? &kw=Reconstructive%20Surgery hope this helps everyone else. the only thing is that you have to have the reconstructive surgery by the end of the year following your original surgery  I am having my RNY on Sept 5, 2007, i have to have my plastics done by December 31, 2008.
Lookin2Lose
on 8/10/07 9:12 am - AL
I looked up your link, and found this:

TRICARE covers cosmetic, reconstructive and plastic surgery to improve the physical appearance of a beneficiary only under the following cir****tances:

  • Correction of a birth defect
  • Restoration of a body form following an accidental injury
  • Revision of disfiguring and extensive scars resulting from neoplastic surgery (i.e., surgery that removes a tumor or cyst)
  • Reconstructive breast surgery following a medically necessary mastectomy
  • Penile implants and testicular prostheses for conditions resulting from organic origins or for organic impotency
  • Surgery to correct pectus excavatum
  • Liposuction when medically necessary
  • Panniculectomy (tummy tuck) performed in conjunction with an abdominal or pelvic surgery when medical review determines that the procedure significantly contributes to the safe and effective correction or improvement of bodily function.

To be covered, surgeries must be performed no later than December 31st of the year following the accidental injury or surgical trauma, except in the case of postmastectomy reconstructive breast surgery or cases involving children who may require a growth period. Were you specifically told about needing to have PS by 12/31 of the year following surgery by a Tricare official, or was this your interpretation?  I'm getting ready to go for my consult soon, so I'm trying to put all of my ducks in a row.  My friend had PS this spring, and she was 4 years PO.  Tricare covered her surgery.

Sporty Jill
on 8/10/07 12:06 pm - Norfolk, VA
Well....I have documented rashes and such and Tricare refuses to approve anyone in this area.  In fact, my PS's office told me that Tricare provides an authorization and then denies the bill because the procedure can be performed at Portsmouth Naval Hosp (if you sit on their waiting list for 2 years). So, I would call Tricare and talk to them as it seems to be an area by area for approval. So...I've elected to have a LBL (with includes the TT) and will be paying out of pocket.  The hosp is going to submit the bill to Tricare to see if they pay any portion of that, but it is unlikely.

     Certified Personal Trainer
                             
"I'm tough, ambitious, and I know exactly what I want. if that makes me a bitch, okay." - Madonna
Beginning Weight: 265  Current Weight:143 
So I run like a Girl....now keep up! 


Most Active
×