Question:
Anyone have Laparoscopic WLS??

I want to hear from everyone that has had Laproscopic WLS approved through Tricare since January 2004. They are denying my daughter saying that Laparoscopic WLS is considered investigational and not the standard of care. They covered my Lap RNY a year ago and I am seeing that several on here have had their surgery Laparoscopic also with Tricare. I would also be interested in hearing from post op's that had their Laparoscopic surgery with a military MD. I truely feel that this is the safest procedure for my daughter. And if anyone has studies that can show that Laparoscopic is safter please email me at [email protected]. Thanks, Jen    — jenafwife (posted on May 31, 2004)


May 31, 2004
If you go to the NIH website, you should be able to find that paper that described laparascopic RNY as the "gold standard" given the shorter recovery time and far fewer risks of complications such as incisional hernias (not that we don't all know of people who had the procedure done "open" who were out and about mere hours after surgery with barely any pain-- but we are talking about general experiences and average types of complications). Try the following sites for the research you'll need: http://www.niddk.nih.gov/health/nutrit/pubs/gastric/gastricsurgery.htm or http://www.nlm.nih.gov/medlineplus/weightlosssurgery.html .GGood luck.
   — SteveColarossi

May 31, 2004
I used tricare Prime in Sept 2003. Approved in 1 day via fax. Comobities have to be 100+ lbs, 40+ BMI,sleep apnea, diabetic, joint pain to name a few
   — Super M.

May 31, 2004
I had my surgery December 19th 2003 laparoscopic through Tricare at Wilford Hall in San Antonio. It's been under 6 months and I have lost 92 pounds. I have had absolutely no problems. I did have sleep apnea, but that was it. I would just keep fighting the issue with Tricare. Call the hotline and see what else they have to say.
   — Monica D.

May 31, 2004
As Steve said, the lap RNY is the "gold standard" of care for WLS patients. If you decide that the RNY is for you though, and you find a surgeon that you are comfortable with and confident in, and they only do it open, the there is no internal difference and you should go with your instincts. I know many who have had their WLS open and are doing very well. I think the main diffrence is the possibility of issues with the surface wound, not the mechanics of the actual surgery. Even if you decide that the lap is for you, your Dr. will most likely tell you that there is a possibility of the surgery changing to open if they encounter something that won't permit a lap. Sometimes there can be an unusual anatomy, or there can be extreme amounts of scar tissue from previous surgeries that you may have had. As I said, the most important thing is choosing the procedure that you want, and choosing a Dr. that you are comfortable with. Good luck.
   — Fixnmyself

May 31, 2004
HI, I had my Lap RnY on the 5th of February,2004. In Dothan Alabama, by Dr. Steven Fendley. I have Tricare Regular, had NO PROBLEM with it! I also have Medicare. I got approval thru both Insurances in less than a week. How old is your daughter?? How is her health other than being overweight?? ......I was told that Tricare Regular will pay for 2 Plastic Surgeries to get rid of access skin as long as my surgical doctors say I need it. Hope this helps.
   — cindirella

June 1, 2004
Hi. You may want to make sure they are denying Laparoscopic surgery and they don't have it confused with LapBand. The first time my doctor submitted to BC PPO I was denied because the doctor had requested LapBand (which is a ring around the stomach, instead of stapling) and it was denied because it is "experimental". He resubmitted specifying Laparoscopic and I was approved right away. Make sure they have the correct name of the surgery. Cindy
   — nacindy

June 1, 2004
Lapband is the experimental surgery that most insurances in the North are denying. Laparoscopic surgery is a method of surgery that is not solely related to WLS, it is a non-invasive surgery in using microscopes with pin-like incisions. Someone has mixed somewhere, have the medical office reapply or call the insurance to explain. This surgery method is one of the safetest as my sister just had a tumor removed via laparoscopic surgery.
   — Anna M.

June 2, 2004
I had laparscopic RNY done in April 2004 paid for by Tricare but done by an outside civilian contracted provider. One of two things may be happening...one the request was not clear and like messages before they may think it is a Lap Band. Or secondly depending on what area of the United States your daughter is in, the Tricare insurance may have different rules and restrictions. Each area is managed by a different company though most are managed by HealthNet Champus Division. Does your daughter have Tricare Prime? Dependents on the West Coast are not seen my military MDs for this procedure, they are sent out in town to contracted providers.
   — Lisa O.

June 2, 2004
She was denied for the Laparoscopic Gastric Bypass. No mistake. She has had the appeal denied also. We were told that she will have to have it done "open" I was just curious if the Military Dr's are doing the same procedure with the Lap method which would not support their denial on it being a non proven method. I think its crazy since they still approve other types of surgery to be done Laparoscopic without hesitation.
   — jenafwife




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