Tricare and Plastics

Hello everyone, 

I am a year post -op and know beyond a doubbt that I need to start the process for plastics asap.  I have tricare prime for insurance and wanted to know if anyone has had success with tricare in getting approved and if so what they needed from their surgeon in order to get said approval. Any and all help is appreciated. 

 I have tricare prime and got a referral from my pcm. I went to the one they suggested and he said I do not file insurance for surgery. I had to get another referral and am now looking for a surgeon  who will accept it. I am going to start calling the list from tricare on Monday. I have been told they are good about coving the surgery but finding the doctor is the hard part.I am interested if anyone else has answers.

Thank you for the input.  Hopefully I can find a doc up here that will do the paperwork.  I really want humpty dumpty put back together again,lol.

I have Tricare Prime, and the easiest way to get coverage is to go through an MTF...if you are treated on civilian side they usually require a loss of 100 pounds, skin issues such as rashes, or a pannus that hangs below the pubic area.  I have also heard they cover breast reductions fairly easily and you can get the lift at the same time.  I have been told everything else is harder to get covered.

I had been approved and scheduled for the full TT with MR last week, but I chickened out at the very last second....good luck to you!

I really only need the tummy and a breast reduction done... I have lost a total of 153 pounds w/ssurgery so I meet that criteria.    My pannus does cover my area, so no problem there either (I hide it very well)  It is just skin, skin, skin!  I have had a few documented rashes via doc as well.   I am considered tricare prime remote as there isn't an MTF where my hubby is stationed (I see civilian docs for everything, even my wls surgery, approved 1st try), so I have to go the civilian approval route unless I am willing to wait 17 more months for our next PCS.  I am not sure about the girls though getting approved since I am a 32 DD (long) now  from a 46/48 F.  Is that enough
to qualify?

Hopefully I can get it approved through civilian doc but if not, hopefully our next base will have an mtf.


Edited to add:  Thank you for answering

My friend's TT was covered by Tricare Prime locallly (she also did RNY locally). There isn't a MTF base here and was denied the reduction. She had to be 400 or 500 CC's in each breast (can't remember completely) so I am guess Tricare goes by that.

Getting at least the panniculectomy covered is pretty easy with Tricare if you have documented skin issues.  Finding a surgeon that will take Tricare is the trick.  Where are you?  Perhaps if you post your location someone will have a recommendation for you.

Red

Thanks so much for asking about this. I'm a few months behind you but I too am going to need the reduction for sure. Not sure about the TT and the extra skin on the legs. I hope Tricare will cover that. Being we are stationed overseas..not sure what I will have to do to find an English speaking Dr. in germany LOL!! So keep us posted as to what is needed to get everything approved. Thanks again....BTW you look great

I have Tricare Standard and I was denied.  Hopefully Prime has different criteria.  Good luck.

I had Tricare Prime and was approved easily for a breast reduction (but I ended up not using it and self paid, but had nothing to do with Tricare). The dr who did my RNY (which Tricare paid for) said they wouldn't have a problem getting tricare to pay for a full tummy tuck. they deal with Tricare all the time and since I was already seeing him it should get approved. I didn't go that route though and just paid for the tummy tuck myself as well. Good luck.


ETA: I also know that sometimes it depends on the Tricare region you are in. I didn't have any problems with my RNY or Breast reduction approvals in Tricare South, but a friend of mine in another region had a harder time getting approved and had to have more things done before her surgery than I did.