Tricare and TummyTuck/Breast Reduction

Hello everyone.  Well due to the type of insurace I have(Tricare Prime), I know that it is much easier to get started sooner than later so that I meet all of their requirements and jump through all of their hoops.  Today I am 155 at 5'4'' tall and am 8 months out from my RNY.    I know that I am not done losing but know that I will need a breast reduction/lift and have my panni removed.  I am tryingt to get some insight from others who have successfully had Tricare cover tese two things and what was needed to make the process as smooth as possible.  I would not be looking to have surgery until after I am a year out and have slowed or stabilized a bit but don't want to wait to start then when I could be prepared now and just have everything set to submit wen my loss has leveled out.  I am working so hard along with my tool to get my body where it needs to be and feel that this will complete at least this small part of my journey (the maintainence/diligence never will end). Thanks in advance.

I was not successful on getting them to cover a tummy tuck, and I am also Tricare prime.  You have to have month of documentation including pictures of rashes, skin irritations, and it has to be medical reason for them to cover it.  I just wanted a breast lift, so I did not qualify for them to cover it.  I know some of the plastic surgery clinics at the Military Treatment Facilities do some of the surgeries, but you might have to pay for parts of the procedures. I know Walter Reed does some because that is where I had my WLS.  I checked in to it here at Tripler in Hawaii where we are currently, and there was a huge wait list.  They also only do it around the holidays where there is free OR time, and I would still have to pay parts of it.  It also worried me that they didn't do the surgeries all the time, but just at certain times to stay current on their certifications.  I figured I could get everything done for about the same price in Mexico that they were going to charge me for here.   Good luck on getting yours covered, and congratulations on your weight loss!!!

Tricare is going to be looking for documentation of medical necessity.  They want to know that the excess skin is making you sick.  Start now going to your PCP everytime you get a rash.  Everytime!  You want the doc to give you precription medication.  Don't let them give you the powder and over the countrer fungal cream line.  You want to document persistent skin breakdown that is not responsive to less conventional treatment.  Just going to your PCP once or twice generally will not do it unless the panni hangs below the pubis.  That is the other thing they will be looking at is how far does it hang.  Oh and don't wait until you are ready for plastics to start doing this.  This you can start doing now.

I have Prime also and on the initial request they denied the panni removal. After my PS sent photos and my PCP sent documentation of the skin rashes they approved it right away.  I also have issues with my back pain due to poor posture from the excessive skin just hanging around. Right now they are waiting on me to choose the date. I have little guys in school and a sick husband so I have to schedule the surgery when I have someone to take them to and from school. My next hurdle will be my arms and breast.

I have tricare prime too...ive decided to just pay for the lower body lift and breast augmentation myself...i dont want them just to remove the flabby skin below my belly button and leave my muffin top...i want the muscles tightened and tricare doesnt pay for any of that...but as far as what my PCM has told me...you have to have evidence of skin breakdown ;skin rashes that dont respond to treatment for over 12 months AND over 100lb weight loss AND have stabilization of weight in the past 4 mths AND at least 18 mths out of surgery AND has to have the pannus hanging below the pubic area...and this is just to qualify to get a referral..not approval....yeah..that is just too much...my surgeon at Travis AFB said they wanted me to have the surgery before I got any rashes...but since we moved to Moody AFB this is what ive been told..so I am still researching who I will go to probably in Florida because there are no good plastic surgeons where Im at...Im going to end up paying a lump sum with my tax refund..then trying to finance the rest...so good luck on trying to get tricare to pay for it....its crazyiness....

Thank  you for the heads up, I just got my referral to a plastic surgeon up here already and am hopingall of  for the best.  I have lost 130 pounds total so far and my back pain has been horrible with the more weight I lose as it seems to not want to leave my chest and my belly is hidden well with spanx but is hanging below the pubic area, so I am fine with those requirements if that is what is needed.  My docs have been trying to get me to have a brest reduction for the past 10 years so I don't think I will have a problem with that.  I lost some volume but going from a 44-46 F to a 32-34 F is still a freaking f and only Fredericks carries bras with those dimensions, so that is making it even difficult to bra shop.  I am fine with just a panni as I have very little above my belly button it really is just a hanging apron of skin.

Good luck!  I have Tricare standard and was denied for a pannulectomy, and didn't have the patience or time to appeal.  They were excellent to deal with for the RNY, however. 

As for the reduction ... it was pretty easy for me. I went to my PCP told them I had back and neck pain. also my straps cut into my skin and leave imprints. They referred me to a PS, he went over everything, sent in paperwork on a Friday and I was approved on Tuesday morining. I didn't actually get it done though ... my hubby is getting out on Sept 18th and my PS can't get me in before then. I'm a 36 DDD and they said I would probably end up a C, possibly a D.

Now as far as a TT ... I was going to go through my surgeon who did my bypass. They told me it would be easy to get approved since I hang lower than my pubic bone. I wouldn't need any documentation of rashes or anything. They did say that Tricare wants you to wait until atleast a year. They were going to try and get me done at 10 months because of my situation (hubby getting out), but we are getting out earlier than we though. so I do not know if it would be that easy. They work with tricare a lot as well so maybe they have some kind of "pull" with them, I don't know.

I do know that the different regions of Tricare want and approve for different things. My friend had to jump through many hoops to get her bypass and mine was very easy and smooth sailing. I'm in the south region and she's in I think the west (she's in TX).

Good luck to you.