Tricare

[leelee 0]

I just called the tricare lady who approves all the surgeries overseas, and she said that at the time, they are not covering the VSG. however, she did say that she had someone else call recently and ask about them, and sent an e:mail up to find out about them (the answer was still not at the time). now i'm just feeling a little bit discouraged, because it's going to be a bit harder to find out information. i know of a hospital where my friend got surgery, so i am going to contact them to find out if they perform (and have done it before) the procedure. Still it's a little discouraging when you are dealing with a language barrier and don't want to put all of your buisness out in the open. does that make sense? i mean, i definatley want to find out the information, but it sure would be a lot easier if i could make the calls myself! *sigh* wish me luck!

[Tiffykins 673]

Best wishes. I know that Tricare Prime and Standard are NOT covering VSG at this time. Now, with that being said if you can find a military hospital that is performing the VSG it is approved via MTFs.

I've been through this several times during my Quest for a qualified revision surgeon, and have been researching it for almost a year with Tricare.

It is still not covered by Medicare/Medicaid, and Tricare shows a trend of following suit after Medicare/Medicaid approves a procedure. Both are gov't ran insurance programs to an extent, and Medicare/Medicaid is still considering the VSG as a stand-alone procedure as "not proven to be an effective WLS as a stand-alone procedure".

Don't give up. I know one other member here that is coming to Dallas, TX to have her surgery here in the states because she can afford self-pay and she won't settle for a band or bypass.

[leelee 0]

well, i don't even mind the pay option, i just wonder if they'd be willing to help me out and find out if there is a place here that does it. if not, i'm not too discouraged, because we are moving to england, and i know that there are some ladies on here that have done it there.

[booklady314 0]

I just had my surgery at Madigan Hospital in Washington with Tricare. They called this surgery a sleeve gastrectomy or just a sleeve. You might want to call her again and ask one more time - just to be sure. In my experience, the military has its own language for a lot of stuff.

They did have a 6-9 month pathway to complete before the actual procedure. So, even if they won't do the surgery overseas, maybe they would allow you to coordinate the pathway from where you are so that when you return to the states you're ready to go - it would be worth asking!

Good luck to you!

[leelee 0]

well, our next tour is overseas; so honestly, if i choose to do the surgery, i don't want to wait another four years. plus, honestly, i think that at this point self pay might probably be the best option for me. the only thing that is holding me up at this point is the consult with the surgeon here. if i don't feel comfortable with his answers, i might just wait until we head to england. but, i'll keep you guys updated on whatever i decide.

[Tiffykins 673]

I just had my surgery at Madigan Hospital in Washington with Tricare. They called this surgery a sleeve gastrectomy or just a sleeve. You might want to call her again and ask one more time - just to be sure. In my experience, the military has its own language for a lot of stuff.

They did have a 6-9 month pathway to complete before the actual procedure. So, even if they won't do the surgery overseas, maybe they would allow you to coordinate the pathway from where you are so that when you return to the states you're ready to go - it would be worth asking!

Good luck to you!

It was covered because the VSG is covered at military facilities that offer the surgery.

It's not covered with civilian surgeons or medical facilities at this time.

[booklady314 0]

I did double-check with my surgeon at today's appointment and he confirmed that the procedure they call "sleeve gastrectomy" is the same procedure as the "vertical sleeve gastrectomy".

So, I suggest you talk to you pcm about getting a sleeve gastrectomy at a military facility that does the procedure. With TriCare Prime, my total bill was only $37.

[Tiffykins 673]

I did double-check with my surgeon at today's appointment and he confirmed that the procedure they call "sleeve gastrectomy" is the same procedure as the "vertical sleeve gastrectomy".

So, I suggest you talk to you pcm about getting a sleeve gastrectomy at a military facility that does the procedure. With TriCare Prime, my total bill was only $37.

I think her issue is that she is overseas and their next assignment is overseas (if I remember correctly) none of the overseas MTFS are offering VSG at this time.

[Tiffykins 673]

I found this out this week.

Since VSG is NOT approved surgery outside of an MTF, if you have complications directly related to your VSG surgery, and seek medical care outside of an MTF Tricare can and will deny coverage for such services.

In my own personal situation this can be tricky because I see a civilian PCM, and am not required to be seen on base for any issues.

Just as a precaution to anyone out there having VSG done at a MTF. All of your follow up care will need to be done at that MTF. Sometimes, it's difficult because I know we have to PCS so this is definitely a concern that I will have to consider in the future when we get orders. Just an FYI. This information came directly from my surgeon here in Florida. Annual labs can be done by your PCP obviously, but they need to know exactly what labs to pull including the Vitamin levels.

Hopefully, Medicare will start covering VSG so Tricare can follow suit and this won't be a huge concern.

Just because it's done at an MTF does NOT mean it is approved service by Tricare.

[vmgraves 0]

I just had my surgery at Madigan Hospital in Washington with Tricare. They called this surgery a sleeve gastrectomy or just a sleeve. You might want to call her again and ask one more time - just to be sure. In my experience, the military has its own language for a lot of stuff. :001_cool:

They did have a 6-9 month pathway to complete before the actual procedure. So, even if they won't do the surgery overseas, maybe they would allow you to coordinate the pathway from where you are so that when you return to the states you're ready to go - it would be worth asking!

Good luck to you!

How was it there? I'm about to start the pathway this summer, does it take a long time many weigh ins and such? I went to the seminar and decided on the sleeve The surgeon seems to think its the best. Do they measure your height again and all that? I worry because I am right at like 39 BMI and worry? How long until you found out that you were "officially" approved for the surgery?

Sorry about all the questions I'm just excited:biggrin0:

[booklady314 0]

I was very pleased with every aspect of my care at Madigan. The pathway was educational and I was very prepared for the surgery. They have two support groups that are very helpful (just not convenient times for me). The nutrition program is great. The actual surgery and post-op care was great.

Overall, I say go for it!!!! :thumbup1:

[imblessed333 0]

I have Tri-Care Standard and they are going to do my Sleeve surgery at Eisenhower Hospital at Ft Gordon Ga.

[Globetrotter 1,340]

I have Tricare Standard too and don't have the option of using an Army hospital and my civilian surgeon doesn't take Standard, only Prime and I can't change up my plan till November, grrrr!!

[imblessed333 0]

Oh I am going to an ARmy hospital. I did not know you was going to a civilian hospital. Sorry

[Tiffykins 673]

I have Tricare Standard too and don't have the option of using an Army hospital and my civilian surgeon doesn't take Standard, only Prime and I can't change up my plan till November, grrrr!!

Have you gotten approval with Prime for VSG with a civilian? Because as of last week, I called Tri-West, Tri-North and Tri-South, to confirm that even with Prime VSG is not a covered procedure. I have 2 friends in Cali that have fought to have it with civi surgeons, one took it to the Congressional level was still denied.

The other did all the pre-op stuff after being told it would be covered, they submitted all her paperwork, she qualified for bariatric surgery, but was denied for VSG.

Last I heard, Tricare will not cover VSG until Medicare fully covers it as a stand alone procedure. It's been this way for over a year. I fought, cried, begged, pleaded, and fought some more to have a civilian do my revision from band to sleeve. They would do band to RNY with a civilian, but a big fat NO to band to VSG.

Anyway, if you get approval with Prime, I would like to find out what you did to get it covered. It's only an approved procedure at military treatment facilities that offer the procedure. I know the Naval hospital in San Diego is offering it.

Ok, ok, sorry for the rant, it's just I've fought and stayed on top of Tricare stuff and am interested to find out when they'll actually cover it with civi surgeons.