Best revision procedure for Tricare Prime to cover
Hi, I had a gastric by pass surgery almost seven years ago about 80 percent of my weight is back and I am more mortified then previously. I have tried to get it back on but I feel like it is here to stay. I am always hungry again. I want to have a revision to get this weight back on and feel like I have learned my lesson and would be much more careful with my new pouch of a stomach. What is the best revision surgery to help me get the weight back off and what will Tricare Prime cover. Thank you so much to anyone who can help!
Angela-5'5-218lbs (ugh) I miss being 130lbs:(
Angela-5'5-218lbs (ugh) I miss being 130lbs:(
I had a band placed by a civilian surgeon on Oct 1, 2008 and have had several complications (the entire story is in my blog). Anyways, I ended up calling Tricare. They told me my best option was to get a referral from my PCM to the on base surgeon, and then go from there. If the on base surgeon didn't feel confident in doing a revision (I'm revising to the sleeve), then he would refer me to a civilian and Tricare has to cover it. The surgeon on base is confident that a revision would give me the resolution I want, and I want to make sure that this gets fixed so I don't have to go through complications.
That is the one way to bypass getting Tricare approval. If the surgeons on base, don't/can't/won't do a revision, then they will refer you out to a civilian of your choice. Tricare told me I had to stay within 100 miles of my home MTF. I am having the on-base surgeon send me out to a civilian who I have researched, spoken to, and he has done revisions. I'm not willing to go through another major surgery without checking out all of my options.
Having the on base surgeon refer me over there, is just cutting a step out of the approval process. I don't have any great advice on which surgery to have that will give you the best results, but I've got the Tricare Prime stuff figured out.
Good luck. . .
That is the one way to bypass getting Tricare approval. If the surgeons on base, don't/can't/won't do a revision, then they will refer you out to a civilian of your choice. Tricare told me I had to stay within 100 miles of my home MTF. I am having the on-base surgeon send me out to a civilian who I have researched, spoken to, and he has done revisions. I'm not willing to go through another major surgery without checking out all of my options.
Having the on base surgeon refer me over there, is just cutting a step out of the approval process. I don't have any great advice on which surgery to have that will give you the best results, but I've got the Tricare Prime stuff figured out.
Good luck. . .
Band to VSG revision: June 3, 2009
SW 270lbs GW 150lbs CW Losing Pregancy Weight Maintenance goal W 125-130lbs
SW 270lbs GW 150lbs CW Losing Pregancy Weight Maintenance goal W 125-130lbs
Hi Tiffany,
I would love to know how your revision goes. I am in the same boat as you, banded 05/19/2008 and my revision is scheduled for 06/29/2009. No erosion, slippage, but consistent pain under my left ribs. I currently have 4 cc's in my band. I want to revise to the sleeve, but doc wants me to be completely informed. He wants to do a new band. I am also a military dependent and I am having my surgery at Walter Reed.
If you don't mind, I just want to know how your experience goes. I wish you the best of luck next week.
Lori
I would love to know how your revision goes. I am in the same boat as you, banded 05/19/2008 and my revision is scheduled for 06/29/2009. No erosion, slippage, but consistent pain under my left ribs. I currently have 4 cc's in my band. I want to revise to the sleeve, but doc wants me to be completely informed. He wants to do a new band. I am also a military dependent and I am having my surgery at Walter Reed.
If you don't mind, I just want to know how your experience goes. I wish you the best of luck next week.
Lori
Hi Angela.
What base/post are you at? I am near Fort polk in Louisiana and my husband is retired Army. My 1st surgery was covered thru Tricare Prime and I was able to outside our MTF as we had no surgeon there to do it. So, 7 yrs later, I was in need of a revision and still have Tricare Prime, but this time, they are my seconary insurance, as I work for the Fed Govt and I have BCBS Fed thru my job. A friend of mine recently had her revision and has Tricare Prime and used the same doc I did for her revision and it was covered by Tricare Prime. I think the biggest thing with Tricare Prime is that they want to make sure and save the most money by utilizing a surgeon at the MTF if they can. If not, they will pay for one that will accept Tricare Prime and sometimes pay for the milage as well. Your best bet is to find out of they have a MTF surgeon that will do it, that is if you are close enough to your MTF, if not then you can use one that accepts Tricare Prime to do the revision. Go and see the Tricare Office at the MTF and they can help. If not call them and see.
I forgot to tell you that if your doc writes it up correctly, they should pay to have the stoma revised as I had done. Tricare covered my friend's stoma revision.
I wish you much luck on your journey and the best of health :-)
Carmen :-)
What base/post are you at? I am near Fort polk in Louisiana and my husband is retired Army. My 1st surgery was covered thru Tricare Prime and I was able to outside our MTF as we had no surgeon there to do it. So, 7 yrs later, I was in need of a revision and still have Tricare Prime, but this time, they are my seconary insurance, as I work for the Fed Govt and I have BCBS Fed thru my job. A friend of mine recently had her revision and has Tricare Prime and used the same doc I did for her revision and it was covered by Tricare Prime. I think the biggest thing with Tricare Prime is that they want to make sure and save the most money by utilizing a surgeon at the MTF if they can. If not, they will pay for one that will accept Tricare Prime and sometimes pay for the milage as well. Your best bet is to find out of they have a MTF surgeon that will do it, that is if you are close enough to your MTF, if not then you can use one that accepts Tricare Prime to do the revision. Go and see the Tricare Office at the MTF and they can help. If not call them and see.
I forgot to tell you that if your doc writes it up correctly, they should pay to have the stoma revised as I had done. Tricare covered my friend's stoma revision.
I wish you much luck on your journey and the best of health :-)
Carmen :-)
Amy Farrah Fowler
on 5/28/09 7:37 am
on 5/28/09 7:37 am
You are a "lightweight" as far as WLS goes, but the DS has the best weight loss statistics, and best maintenance of that loss, and the requirements are the same as for RNY. BMI has to be (usually) over 35, OR have co-morbidity's, and you are barely over that, but should qualify.
That said, revision surgery has more risk than a virgin surgery, so you want to make sure you have a good revision surgeon. There is a good list at DSfacts.com, and then I would talk to Tricare and see what they can do for you.
That said, revision surgery has more risk than a virgin surgery, so you want to make sure you have a good revision surgeon. There is a good list at DSfacts.com, and then I would talk to Tricare and see what they can do for you.
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