Tricare Prime and revision

My surgeon put in a revision request and it was denied due the code they used. After speaking with the Dr's office and Tricare, come to find out they don't have a valid code for lap revision, only for open..... and one else have to deal with this? My Dr's office is calling them Monday to see what can be worked out. Other than that code, I meet all of the criteria for a revision. What to do now? Any suggestions would be appreciated!


I was told that many insurance companies over look the generic code that needs too be used, but Tricare does.

Thanks!
Susan

I had my revision covered by Tricare prime. I went from Lapband to VSG, and was approved within a matter of days. I'm not sure what code my surgeon used, but we didn't have any problems getting it approved. I know what a pain in the butt Tricare can be. I'll keep you in my thoughts and good luck ! ! ! I hope they can figure something out for your situation.

I had that same issue.    My first request was denied because of a code for open vs. lap.   My doc moved to a new hospital and new office.   I just waited for him and reapplied again and the insurance clerk there knew what to do to get it approved.    I don't know what she did, but I had my surgery.    I suppose you could try to call them and ask what code they use for this surgery (if they will tell you, I don't know)   Anyway, my doc is Thomas Sonnanstine at Georgetown Community Hospital in Georgetown Kentucky.   I think it can't hurt anything to ask.........