Question:
PS with Tricare

Has anyone had PS with Tricare insurance? How was the process? Please let me know!    — Sabrina H_NC (posted on November 21, 2003)

November 21, 2003
i have tricare too, but i haven't had ps yet because i'm only 3 months post-op RNY. you can go on the tricare website and look up "reconstructive surgery". you have to have it documented everytime you get a rash, back pain, boils ect. to your PCP. if you have all this info then it shouldn't be a problem.
   — franbvan

November 21, 2003
My insurance is Tricare Prime, and I am only 3 1/2 months post-op, so I am far from needing PS yet, but I did call Tricare before my WLS and ask them how it worked with re-constructive surgery, do not even bring Plastic Surgery into any conversation. Plastic Surgery is for people that just need to tighten up stomach, etc according to Tricare Prime. When you have the extra skin we have it is a medical necessity and you are having to have your whole body re-construcked. Anyway, the representive told me that Tricare does reconize that with the amount of weight we lose in such a short time, that when the time is right, and it is medically necessary, we need to have our pcp write a referral for us to have a consultation with a PS due to medical necessity, the PS would then send a referral to Tricare for any surgery we might need. They do give approval for a Panni not adomaplasty (sp) and they have given approval for breast reduction. I have heard that they do not feel the batwings are medically necessity, but I am hoping that my PS knows how to put in for the approval and I can get the batwings paid by insurance, if not I will hopefully be able to pay extra to the surgeon and get them done when I have my breast reduction. You should call Tricare and ask them, do not be afraid of them, just do not say PS remember it is re-construtive surgery.
   — cindy

November 21, 2003
Tricare prime payed for my full tt and breast lift due to the weight of the excess skin causing me back pain. I had both done at the same time.......one word OUCHHHHHHHHHHHHHHHHHHHHHHHHHH. First thing you need to do is see your pcp and start getting documented what the problem is. I had no problem at all with them paying for mine. First they will refer to you ps, after your ps consult the ps will submit pictures (yep nekkid) to tricare along with what he says needs to be done. Tricare has up to 30 days to approve it once they recieve the information from the surgeon. It took them 5 days to approve mine :) kristi ky
   — tinalivesay