revision with tricare

I was scheduled to have lapband revision on my gastric by-pass (2000) that did not work and was not performed correctly.  Tricare has denied me stating they only perform this type of surgery once in a life time.

Does anyone out there have tricare and been granted a revision surgery.  Plan to fight this but unsure how to proceed.  Any guideance anyone can provide would be greatly appreciate.

Thanks
Dot

 
You could try Walter Lindstrom; he is an obesity lawyer.  He won't take your case unless he is sure he can win.  Good Luck!

Are you Tricare Prime, Standard?

Tricare Prime.

This is a new thing with Tricare, I have a few friends here on Prime who see civilians and are getting denials, but once they go through the MTF, if medically necessary, they are getting their revisions. I had my band performed by a civi with Prime and then my revision to VSG due to complications was performed at a MTF without issue. But, that was 3 years ago.

Thanks, the doctor's office is appealing for me.  Since I had complications with the first surgery and they did not form my pouch correctly, I am trying to stay hopeful.  I will fight Tricare to the death for this revision.

I'm also Tricare Prime.  I was approved for a revision with BCBS NC, and am waiting for Tricare Prime as the secondary to give me a decision this week.  I believe they will make me appeal, but I know that my surgeon will try to give them the information they need to show it is medically necessary.  Best wishes to you.  I'm in Raleigh and finding a Dr. that even accepts Tricare has been a chore!

Good luck with Tricare hope you are approved.  Have not heard anything about my appeal but no news is good news I suppose.

Hi Dot,

I saw your post. I hope you  have gotten the answers you wanted with Tri Care Prime. I have Tri Care Prime and am  being seen out at Madigan for a revision. My PCP put in a consult  for a revision and Tri Care approved it within days. If you are close to a large military facility they should approve you quickly. Good luck. I hope by now you have been approved.

PS- My brother in law is a Hochstrasser. He is from the Pacific Northwest but moved to Idaho with my sister to teach college. Its a very uncommon name so your family must be related somehow.