Tricare, Triwest???

[pappyny 0]

Does anyone have any experience with tricare or triwest and plastic surgery? I'm still a ways from my goal, but I want to get the ball rolling now if I can.

I'm wondering if anyone has gotten any kind of plastic surgery approved through tricare and if so, what kind.

I'm thinking that I will need a lower body lift and breast lift with implants. I'm almost 100% positive they won't cover the implants, but not sure about the rest.

I did a search, but didn't really find anything.

Thanks for any help you can give.

[Mimilou2004 13]

Tricare specifically excludes plastic surgery.

Mimi

[pappyny 0]

I have read that in their manual, but I have also heard about other people getting approved with sufficient proof from their PCM and a surgeon. Sometimes it is for a panniculectomy as opposed to a Tummy Tuck or full blown body lift. I was just wondering if anyone on this site has dealt with tricare on this issue.

Do you have tricare?

Thanks.

Karyn

[Mimilou2004 13]

I have Tricare and I just paid for a boob lift and arm reduction.

Mimi

[clayverde 2]

Hi - I have Triwest and I am waiting right now to find out if the panniculectomy was approved. I was told that it is normally approved given the amount of weight loss and excess skin that I have. I keep checking the website, but it still says under medical review. I have high hopes that it will be decided quickly (the approval process for the lapband surgery was just three days) but who knows?

The surgeon was very clear with me that he has never seen an insurance pay for the leg or arm lift. Any portion of it. I know that a breast reduction will be covered by Triwest, but I'm not sure if that surgery would also be a breast lift or what. The surgeon I am using works at the same hospital that I had the lapband done. He has worked many times with lapband (and other weight loss patients). He feels strongly that any and all possible surgeries I would consider doing should be done individually and with time between them. He said that patients like us can often have a higher rate of complications - he feels that keeping the surgery time limited and focused on one thing helps reduce possible complications, etc. Plus, he said that it is very difficult to know exactly what the skin and shape will look like when it heals. So he said it helps to let everything heal and settle and then take a look at the boobs or arms, etc. So, for instance, when he takes a look at my boobs AFTER the Tummy Tuck, he will have a better idea of what the size and shape, etc. of the boobs will be best especially in comparison to where my belly is then. What the proportions will be. (I hope that I'm making sense there... I understand it but I'm not sure I'm explaining it well.) While I am of course anxious to get it all done and done RIGHT NOW, I am of course also concerned with my health (what point is having a flat tummy but a massive staph infection??). Also, as soon as he explained about wanting to take each new surgery be able to see exactly what will look best in relation to what my tummy actually looks like, instead of what he thinks it will look like once the swelling goes down. And, frankly, this allows us to save up money for each new thing.

Anyway, so the tummy tuck is definitely NOT covered by Triwest but the panniculectomy often is if the surgeon provides pics and evidence of the medical necessity to remove it. Of course he recommended the tummy tuck for a few different reasons (the repair to the abdominal muscles, the fact that the tummy tuck removes more skin and fat than the simple panni, and the additional Lipo etc gives a better looking final result) but of course that is not covered. We were able to talk to the hospital and (hopefully!) Tricare will cover the panni and my husband and I will pay the difference to the tummy tuck. That way, I get the results I want but my insurance covers at least a portion, which is what made coming up with the money for the difference much easier.

Obviously, I'll keep you updated as I get approvals, etc.!! Good Luck!

[Mimilou2004 13]

Clayverde....I like your PS's attitude. I am sorry I didn't have the TT first because I think it would have affected how he did my breasts, but it is a done deal.

Best wishes,

Mimi

[BroncosGalAndrea 0]

I have tricare. They covered first the lap band (and all the subsequent visits since then) AND my breast reduction. I was having problems with my back. Went to see my PCM, she got approval for a consult with the plastic surgeon, who in turn, told tricare I was a perfect candidate for the reduction for various reasons including back pain and it would make the weight loss/lap band easier since with smaller boobs, i'd be able to do more exercises.

I'm in the process of starting on an approval for the panni surgery. I get a terrible rash under the fold of the tummy. The creams they prescribe do not work. Now the rash/infection is starting to be quite painful! PLUS i have a hernia. MEdical reasons. So, yes, TriCare WILL cover some plastic surgeries, under the right circumstances.

Hope this helps.

PS - From the time I first went to see my PCM to my breast reduction surgery, the time frame was like 6 weeks. I'm hoping for the same result for the panni - i plan on seeing the same PS. Good luck to you!

[BroncosGalAndrea 0]

***UPDATE****

TriCare FINALLY approved my tt (and subsequent hernia repair) and it was deemed medically necessary because of terrible and painful rash/irritation. Surgery is this coming Monday. Once tricare had all the paperwork, it only took like 48 hours for them to approve it and a week and a half for the surgery. You MUST start off with your PCM, have them ask for a referral to consult with the PS, then the PS submits the referral for the surgery/surgeries.