Tricare Standard/Revision
I have finally been approved by Tricare for a revision.I had to appeal it all the way to TMA n get a peer review.I had lsp rny in 2006.I would like to have the sleeve which my doc recommends but I don think Tricare covers and in the review from Tricare the reviewer noted he was opined I should do Duodenal Switch.The codes my doc put in to get approved was 43846,43644,43848,43842. Any advice on what would be best to procedure to get my appt. is Friday to go over my options.
My doc has recommend the sleeve.But Tricare peer reviewer opined Ds.But the approval letter just states approval of Revision of Gastroplasty.I have been reading about the sleeve and ds and they both seem the same.I guess I need to call Tricare to see which surgeries they will pay for then go from there
Wow....you are very lucky!! I have Tricare Prime and could not get approved for a band over bypass. I wonder if it was because I had only gained 50lbs. I do know that they do revisions from RNY to DS at Madigan (the hospital at Ft. Lewis, WA). I didn't want a DS as I have enough issues with vitamin deficiencies from my RNY (I have to take multiple shots every weeks from them). Best of luck to you and let me know what you decide.
If you get approved by Tricare for a revision to DS or a sleeve I would love to hear about it. This would be a first I would hear of Tricare covering it. I like another poster couldn't even get approved for a band over bypass. I do know Madigan Base does them and couldn't get them to do it there because I have Tricare North and they are West. I just can't even believe a reviewer would suggest a DS when they don't even cover it for first time gastric bypass patients. Do you medical complications? I was denied for the band over bypass because they said they have a one per lifetime clause (even if you didnt use Tricare for your original surgery) UNLESS there is a medical reason (not just gaining weight back). Thanks!
My surgery is Wed Sept.19...Cant wait only bad thing is I sprained my foot over the weekend but other than that I am so happy to get this revision.We had Tricare Standard but now Prime due to him getting activatied.The medical complications I have is highblood pressure,gerd,diabetes,gallbladder issues, had a small bowel resection and weight gain.All I did was look up there criteria for wls and revisions and worked to get the info they needed together and didnt give up. I thought the clause was for people who already used Tricare for their surgery.Also before I had wls in 2006 I didnt have hb,diabetes,or gerd.The last 2-2.5 year I have been having these issues.
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