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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