NEED HELP WITH TRICARE AND SKIN REMOVAL

PitbullMomma
on 12/17/12 5:10 am - richalnds, NC

i've tried so many times to get tricare (military health insurance) and they keep denying me saying i dont have any medical reasons for surgery when my therapist has even written them to validate mental issues and they still say no. what can i do if anything??

 

im 26 yrs old 5 yrs out of WLS total loss of 155 lbs with sustained 110 loss

acbbrown
on 12/17/12 6:02 am - Granada Hills, CA

You need to get a copy of your benefits/exclusions/requirements and see what it says. If they require you to have a medical reason like rashes/infections, then that's what they require (and it would be pretty normal in that category). Unforunately, a letter from your therapist won't help with that. 

www.sexyskinnybitch.wordpress.com - my journey to sexy skinny bitch status

11/16/12 - Got my Body by Sauceda - arms, Bl/BA, LBL, thigh lift. 


HW 420/ SW 335 /CW 200    85 lbs lost pre-op / 135 post op
  
~~~~Alison~~~~~

 

Iam_with_the_Band
on 12/17/12 3:16 pm

Unfortunately, I have not heard of any medical insurance who considers mental issues a reason for plastics.  I know - we all know different, but they require hard core proof of medical issues. 

I have paid cash for all of my procedures.  I lost over 300lbs and they still denied it -

12/09 and 6/11, 9 skin removal procedures with Dr. Sauceda in Monterrey Mexico
Revised to the Sleeve after losing 271 lbs with the LapBand. 

Laura in Texas
on 12/17/12 10:43 pm

You're young. Start saving to self-pay. Get a second job, make sure your credit is good so you can get a loan. Go through a residency program to save money. Where there is a will, there is a way.

Laura in Texas

53 years old; 5'7" tall; HW: 339 (BMI=53); GW: 140 CW: 170 (BMI=27)

RNY: 09-17-08 Dr. Garth Davis

brachioplasty: 12-18-09 Dr. Wainwright; lbl/bl: 06-28-11 Dr. LoMonaco

"May your choices reflect your hopes and not your fears."

Iam_with_the_Band
on 12/18/12 12:05 pm

Laura, you're right.  When you're young and able bodied, anything is possible.  After losing all of my weight (well, almost, I feel like I am young and able bodied again!  Working 9 - 12 hour shifts in 2 weeks is possible.  I'm saving once again for my plastics.  Working two jobs - living in a studio and selling my car got me my plastics -

Life goes on and we learn that when we value something bad enough, we work hard to get it!

12/09 and 6/11, 9 skin removal procedures with Dr. Sauceda in Monterrey Mexico
Revised to the Sleeve after losing 271 lbs with the LapBand. 

PitbullMomma
on 12/29/12 3:25 pm - richalnds, NC

i maybe young and able and all that but i have a family. working 30 hrs a day 7 days aweek and not bein a mother or wife is out of the question. and puttin my family into that kind of debt is beyond unreasonable.

Iam_with_the_Band
on 12/29/12 8:18 pm, edited 12/29/12 8:19 pm

It is never easy. Working two jobs and being a single Mom has been very difficult. I paid cash for my Lapband too. Medical insurances have rules and regulations. Some very fortunate have plastics covered, many more do not. Each of us and our families make choices, we make sacrifices. There is not one of us without mental anguish from the excess skin we are left with after weight loss. My pcp was furious my medical insurance would not pay. I did the hard work of losing over 300 lbs. I was left with 19 lbs of excess stomach skin and chronic back pain.

yes, it is not right, but you are not alone and sometimes it is better to make a plan and take care of our business ourselves. You are married, maybe you could get a part time job and your husband could take care of the kids. If you really want this, you will do the hard work. Being young and able bodied is on your side. *****ing about how it is a crock of **** and making excuses is not. I know I sound harsh, but I worked hard for mine just as many of the rest of those self payers have. 

12/09 and 6/11, 9 skin removal procedures with Dr. Sauceda in Monterrey Mexico
Revised to the Sleeve after losing 271 lbs with the LapBand. 

Laura in Texas
on 12/29/12 9:23 pm

I totally agree, Dee!! I made a plan and did it. I have done this my whole life. I am single and a teacher living on a modest salary. Somehow I have managed to pay for 2 international adoptions and a lot of plastic surgery. Too many people sit around feeling sorry for themselves and expect others to do things for them. I believe that is the main problem in our country. Thank you for being one of the people *****stores my faith in humanity. You are my hero!!

Laura in Texas

53 years old; 5'7" tall; HW: 339 (BMI=53); GW: 140 CW: 170 (BMI=27)

RNY: 09-17-08 Dr. Garth Davis

brachioplasty: 12-18-09 Dr. Wainwright; lbl/bl: 06-28-11 Dr. LoMonaco

"May your choices reflect your hopes and not your fears."

Iam_with_the_Band
on 12/30/12 6:25 am

Laura, Imagine the amazing role model you are for your daughters.  I know my daughter has told me several times that she learned from me that hard work is the answer, *****ing and moaning is not.  I am proud of her.  I hope that she never has to work as hard as some do, but I know that she will if she must.

I can't tell you how rewarding it is when I pay off a bill or wired my cash to my surgeon for my surgery.  Knowing I did it myself and will reap the benefits is the best. 

You are my Hero too!

Hugs and Happy New Year!

12/09 and 6/11, 9 skin removal procedures with Dr. Sauceda in Monterrey Mexico
Revised to the Sleeve after losing 271 lbs with the LapBand. 

Robert Oliver
on 12/18/12 10:00 am - Birmingham, AL

Do you have any pictures to give us an idea of what kind of frame and skin excess you in fact have?

 

Tricare's fairly restrictive on their candidates. If you aren't an unusual or extraordinary case then you're likely paying out of pocket.

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