Tricare Prime (Overseas)?

[clk 3,519]

I'm new and considering VSG. I was reluctant to pursue any WLS but my last doctor suggested a band to me. After reading/researching for seven months I don't think it's the right option. I do need a restrictive procedure but my biggest issue is that I always feel hungry, no matter if my belly is full or not (and it's not always head hunger, either!), so I think the VSG will provide a better solution for me. I can see myself suspended in a special sort of hell with the band - unable to eat but still always starving, and having my food options limited, too!

My question is about Tricare and VSG. I read on another thread that Tricare is going to start covering VSG very soon. How soon? Does anyone have more information about this? I cannot find anything about it online. I know they cover bands and RNY with no problems, I'm just curious about this procedure. I definitely meet the Tricare requirements for WLS.

I'm torn. I'm not sure if I should accept the band knowing it will likely require a second surgery at some point (but doing it anyway because insurance will do it for free) or if I should find a surgeon and do a self-pay for the VSG because that's what I really want.

In any case, info on the Tricare issue would be appreciated.

~CLK

[Tiffykins 673]

I'm a military spouse with Tricare Prime. I'll preface my response and tell you that if you can hold out until after the 1st of the year, and get the sleeve, do it. I had a band, it was hell. I had the major issue of not being able to get restriction, and being hungry all the time.

Tricare paid for my band, and my civilian surgeon (that Tricare referred me to) disregarded my concerns and pain with a flipped port. So, I went to our neighboring base here in Florida with a referral for a revision to the sleeve. BEST DECISION I ever made, literally.

I hated my life with the band. It was miserable, and Tricare Prime covered my revision 100% no questions asked. There are many stateside MTF's doing the sleeve at this time, and have been for at least the last 2 years.

Just to give you an idea of my band experience:

October 2008 - Band placed Flipped my port (or at least ripped my anchor sutures and the port flipped soon thereafter) in the hospital the day of surgery because a nurse had my pull myself up in the bed after going for a walk.

First fill came 6 weeks later

Lost 23-25lbs the first 2.5 months then the swelling from surgery went down, LOST all restriction. Next fill came in January still no restriction.

Begged for a fill didn't happen until mid-February

Pain in my port area had managed to get to a 6-8 some days (on a pain scale of 1-10, 10 being the worse), and the surgeon at the time would not address the issue even though I told him that my husband and I could not have sex some days because the pain was so intense.

In March, after begging again, I went not for just 1 fill, but 2 under fluoro because he could not longer access my port, because it had literally moved in my abdomen. LOVELY. I endure almost 40 minutes of him prodding around trying to get to the port under fluoro, and then he finally told me to just diet, and eat smaller portions, but don't work out because it would cause more issues with my port.

From the January fill to June 3rd, 2009 when I had my revision, I gained about 16-17lbs back. So, technically, I only lost 7lbs with the band in an 8 month time frame. Since having my revision (June 3rd 2009), I've dropped 107lbs.

A week later I started researching my options with Tricare. I found myself at Eglin, and got approved the day of my consult for my revision.

It's been rumored that the VSG should have full approval shortly after the first of the year. Since you are overseas, I would highly recommend researching surgeons. There are several MTF's here in the states that are performing them, and that are the preferred surgery. My revision surgeon wanted to just do a port revision. Luckily, I told him that there was something wrong with my band. I could literally feel the tubing of the band pulling on my stomach. The band damaged my stomach severely. If you can hold out for VSG approval, I would highly recommend it.

The band is very tempermental. My mom has had one for over 2 years, and she gets food stuck 3-4 times a weeks which leads to her puking up her dinner. She came to Florida for a visit from the Texas, and the humidity here didn't allow her to eat anything but mushy foods because solids would not go down. She's only lost 75lbs in 2 years, and she just thinks her "band issues" are normal and deals with them.

[clk 3,519]

Thank you so much for the helpful, detailed response.

I have no doubt I can wait until January for the surgery. I had to re-start the process once we got here and I'm still waiting for my appointment with the nurse that refers everyone to the surgeon. Here they make everyone go to one person who handles all referrals for WLS.

I'm hoping they'll be able to do it at Landstuhl, which is only an hour away, but if I have to find someone off post I think that will be trickier.

In any case, thanks. I'll keep my appointment next week and go from there.

Thank you for the response - you really helped confirm my belief that the band is not the way to go. I'll just do my best to get Tricare to cover the VSG instead.