Tricare Anyone?

[BZButterfly79 19]

I had my first class on the 12th of Oct, am meeting with my nutritionist on the 19th of Oct, and then the nurse said I will be scheduling a visit with the doc...meanwhile I will have booked a Psych consult which is due after I see the Doc? Is this the usual course of events I am really praying to start my new life before the end of the year. If you are a military dependent and can share your experience, I am also having it done at a military base(per Tricare) I hope that goes well too. The surgeon seems to do these frequently but the military docs are so young that you get a little scared.

And...can you share with me some of the important things your asked the Doc because I am making a list, they told us to write down all of the questions and concerns before the appointment.

Thanks

[christina@MIA 12]

Hello again fellow Military wife,

I have Tricare but I was self pay. I went to Mexico because I didn't meet Tricares requirements. The best person to talk to on this sight is Tiffykins. She had it done on a Military post and knows the ins and outs of Tricare.

Good luck

[clk 3,519]

The first thing to point out is that Tricare does not cover VSG. They will not cover it in the next year, either, according to the half a dozen folks I talked to within Tricare.

However, several MTFs, independently of Tricare, will perform the procedure on a wait list basis. They typically have you meet the same requirements for them to do the sleeve as they do for their other bariatric surgeries.

It's important to keep the issues separate, because it confuses people. Availability of surgery in your area is purely based on whether or not your local MTF is doing the sleeve at this point.

The military docs aren't as experienced because it's so new and it's not a covered procedure yet. However, every surgeon that does the procedure was new at some point. You'll have to decide your comfort level on this one. If everyone avoids the new surgeons, they can't become experienced surgeons. I'd be more comfortable if the surgeon had a ton of RNY experience, though. I know there are a handful of people on this forum that had the surgery done at a MTF, so you should search them out.

I'm a military dependent. I'm overseas and since Tricare does not cover the sleeve and we have no local MTF that will perform the procedure, I opted to self pay. I can't help you out with the military procedure because I went no farther than the metabolic testing and nutrition class before I was told it wouldn't be covered unless I chose the band or RNY.

You'll need to decide what your worries are, but I'd definitely ask about acid reducers, since I couldn't live without mine. I'd also ask about supplements, post op diet, and aftercare (like the upper GI at 3 months post op).

Good luck,

~Cheri

[Tiffykins 673]

I had my VSG revision at a MTF, and had an amazing experience, top notch care, and my surgeon is phenomenal. My surgeon had performed a couple hundred sleeves, and even more RNYs, plus he'd removed bands and done revisions. Even though he is "young" (under 40), his skill level was perfect. Tricare doesn't approve VSG outside of a MTF, but more and more military hospitals are starting to offer the procedure, and some even prefer it over the other options. I've had 4 friends use the same MTF, and all had the VSG scheduled and performed within 6 weeks of their informational seminar. Best wishes on your journey, and if you have any specific questions feel free to contact me.

The process is fairly seamless with the military. I did have to fight for my revision since I had already had 1 WLS with the band, but I fought and won.

My process was similar to yours except since I was a revision, I was able to meet with the surgeon first then do the psych consult. I was allowed to skip the nutrition classes since I had already met that criteria with the band just 8 short months before my revision.

Here are some questions that you might want to ask.

Pre Op /The Op

Is there some follow up care, like labs at 3,6,9 and 12 months?

Pre op diet - what to eat/drink and how long for?

What size bougie is used? (This is the medical instrument which determines the size of your remaining stomach)

Do you oversew the staple line?

How many incisions do you make?

Do you go in thru previous scars?

How many nights in the hospital is there facility for someone else to stay in my room as well?

Do they need to be with me 24/ during my hospital stay?

How many leak tests do you do?

How many sleeves have you performed?

Complication/leak stats? How many if any deaths?

]Who do I contact if I think I have a problem (most places give out an emergency number)?

Is the hospital equipped an ICU and blood bank in case of complications?

If complications do happen to occur, are these complications/additional surgery/days in hospital covered by the original quoted price of the surgery?

Would you remove my gall bladder at the same time if needed?

Can you give me some patient testimonials or do you have any before/after pictures of your patients that I could read/look at?

Is it standard operation procedure, ie: no nail polish, no body jewelryy?

Do I need to stop taking any particular medication pre op? (Take a list of what you take and dosage)

Post Op

How often are the post op check ups?

Where are they? is price included?

]What supplements/anti acid drug would I need to take and for how long?

Do I need labs done post op? Are these checked with you or my local doctor?

DO I get a dvd of the operation?

Post op diet?

How much weight would I be expected loose?

What if I loose too much, how to maintain?

Do you use heparin? Will I have to inject it myself?

How soon after the op can drive, swim, work out, lift weights, lift my kid?

Will you send me home on a true acid reducer like Prilosec, Nexium?

[Robin Lanzoni 1]

Newbie here... I sure hope I don't sound stupid but, how do I find an MTF? I live in Cape Coral, FL (Near Ft Myers). My husband is in the National Guard. He's home right now but is leaving for Afghanistan in February (he's already deployed 3 times to Iraq before this). I'm on Tricare Standard right now but I think I could have Tricare Prime when he deploys.

When I started the journey to decide what was best for me, I first called local Bariatric surgeons asking if they accepted Tricare at all. "No no no" was all I got so I finally called Tricare and the closest Bariatric Surgeon that accepts it is in Tampa (about 2.25 hours from here). Originally I wanted the lapband but, as I've researched, it just does not seem like the right choice. I work full time and it would be extremely difficult to drive to Tampa every 6 - 8 weeks for fills for the rest of my life. I've been to a seminar locally but the Dr in Tampa won't see me until I've been to HIS seminar. Understandable but, when I called his office to ask them if they know if Tricare covered the sleeve, they wouldn't answer the question. They just kept saying that I had to attend their seminar first, then I could make an appointment and insurance/options would be discussed. I said, "I don't want to drive over 2 hours to attend a seminar just to find out the procedure I think I want will not be covered. Can't you just tell me now?" Nope. I have an autistic child and getting away from the house for extended hours is difficult.

I've read about people getting the sleeve at MTF but I don't know where to find one. MacDill AFB is also in Tampa but I don't know if there's an MTF there. Even though my husband has been deployed so much over the years, I feel left out of the loop of the normal, full-time military wife. I don't have any other military wife friends. Can you give me any advice?

Robin

[Tiffykins 673]

Newbie here... I sure hope I don't sound stupid but, how do I find an MTF? I live in Cape Coral, FL (Near Ft Myers). My husband is in the National Guard. He's home right now but is leaving for Afghanistan in February (he's already deployed 3 times to Iraq before this). I'm on Tricare Standard right now but I think I could have Tricare Prime when he deploys.

When I started the journey to decide what was best for me, I first called local Bariatric surgeons asking if they accepted Tricare at all. "No no no" was all I got so I finally called Tricare and the closest Bariatric Surgeon that accepts it is in Tampa (about 2.25 hours from here). Originally I wanted the lapband but, as I've researched, it just does not seem like the right choice. I work full time and it would be extremely difficult to drive to Tampa every 6 - 8 weeks for fills for the rest of my life. I've been to a seminar locally but the Dr in Tampa won't see me until I've been to HIS seminar. Understandable but, when I called his office to ask them if they know if Tricare covered the sleeve, they wouldn't answer the question. They just kept saying that I had to attend their seminar first, then I could make an appointment and insurance/options would be discussed. I said, "I don't want to drive over 2 hours to attend a seminar just to find out the procedure I think I want will not be covered. Can't you just tell me now?" Nope. I have an autistic child and getting away from the house for extended hours is difficult.

I've read about people getting the sleeve at MTF but I don't know where to find one. MacDill AFB is also in Tampa but I don't know if there's an MTF there. Even though my husband has been deployed so much over the years, I feel left out of the loop of the normal, full-time military wife. I don't have any other military wife friends. Can you give me any advice?

Robin

Hi there. . .

Yes, you can switch to Prime when he deploys. You will not be covered for the sleeve with Standard unless you find an MTF to take you with Standard which is a rare, rare, almost never happens find. Here's the catch, since VSG is NOT a covered procedure, anything you have done upon his return and you go back to Standard MIGHT not be covered by Tricare. Now a way around this is to have your PCM pull annual labs for you, but NOT mention it is follow up care for VSG on the coding. There is minimum follow up after the first few weeks. For example, many patients go abroad for surgery, come home after 48-72 hours, and only have labs performed annually by their PCM, and they are doing fine. My MTF requires follow ups every 6 months for the first 3 years. But, we do have free access to psychs and nutritionists if needed. I recommend that your PCM communicate with whichever surgeon you get to perform your surgery. I'm up in the NW Florida Panhandle by Pensacola. Eglin AFB is where I had my band to sleeve revision performed.

MTF Locator.

http://www.tricare.mil/mtf/

Tricare won't cover the sleeve outside of MTF or VA hospitals. So don't waste your time trying to jump hoops for that surgeon. It won't work. I've fought for myself ( and with friends) in every Tricare area, Tricare South, West and North. One friend went congressional and still got denied through a civilian after getting pre-approval and everything.

You'll have to put in some footwork to find an MTF that will take you on as a patient for the sleeve. But, I will say that you should not settle for just any surgery. The band really does suck especially if you can't get fills/unfills easily. I've been there done that, and had all the lovely band issues that come with it. Certain plans with Medicare are starting to cover the sleeve, Tricare might be following suit, but I've been hearing that trash since January 2009. But, Medicare wasn't covering the sleeve at all, now they are on some of the plans. So, fingers, toes, every part crossed Tricare pulls their head out, and will start covering it.

If you need help, please feel free to contact me. I've been through the trenches with Tricare on this issue. I know how the process works as most MTFs follow a similar program.

I'm more than happy to help.

[pcos_chick 23]

I live in DC... but the DC program is full... I begged, pleaded and was accepted in to the program at Portsmouth. (And yes I have to do all visits, labs, etc down at Portsmouth.)

Their program goes like this:

- Get referred to general surgery for the program

- Program orientation

- Labs, EKG

- Initial Surgeon Visit

- NUT (they say to expect at least two NUT visits)

- Psych

- Second Surgeon's visit - potentially get surgery date

- Surgery

Hope that helps!

[Dawn 16]

I live in DC... but the DC program is full... I begged, pleaded and was accepted in to the program at Portsmouth. (And yes I have to do all visits, labs, etc down at Portsmouth.)

Their program goes like this:

- Get referred to general surgery for the program

- Program orientation

- Labs, EKG

- Initial Surgeon Visit

- NUT (they say to expect at least two NUT visits)

- Psych

- Second Surgeon's visit - potentially get surgery date

- Surgery

Hope that helps!

Do you know about any support groups they have in the DC area? I might be moving to Ft. Meade here shortly and would love to continue with a support group! My surgeon and NUT both said today that Walter Reed is a FANTASIC place for WLS!!

[pcos_chick 23]

Well.... they aren't doing it at Walter Reed any more.... sorta..

BRAC is moving Walter Reed operations to Bethesda. In the DC area you can get surgery (when they have wait list space) at Bethesda (aka the Walter Reed National Military Medical Center) and Ft. Belvoir.

[sasicas 194]

Each base you will find different criteria. The base here starts with a referal from your PCM. Once Bariatric services recieves that referal they call and have you go to a big orientation, at which time you are put on the waiting list.

Once your name comes up on the waiting list you officially are entered into the program, you then have the following appts...

Appt with the case manager

Yearly physical

2 NUT appts

Support group (attend at least once)

Goal setting class

Stress management class

*then a call into Case manager to get referals for next appts

Pysch appt, includes a written "test" and meeting with the dr.

Surgical clearance with your PCM and any other specialty drs you have, additional testing may be required if you are seen by any specialist

Consult with the dr. at which time surgery is scheduled

Surgery generally is about a month out from there and you have a 2 1/2 day stay in the hospital

[2BSkinny 0]

I had my sleeve performed on Oct 26th at Naval Medical Center Portsmouth by Dr. Mann. Someone else on this thread mentioned the program at NMCP. There are 3 or 4 surgeons who perform bariatric surgeries, but Dr. Mann is the only one who has performed or will perform a sleeve. He usually provides this surgery only as stage one of a two step surgery for those who are too heavy to safely undergo a bypass. I was convinced the sleeve was for me and he "caved" . The NUT, Psych, bariatric case manager, etc... all thought I didn't know what I was talking about when I said I was having a sleeve, that he hardly performs them and he certainly wouldn't perform one on me with a bmi of 40. I guess I "got lucky". Anyway, it IS possible to have a sleeve at Portsmouth. It's just very rare.

If anyone has any specific questions for me about my experience with Tricare, Dr. Mann or NCMP, I'm happy to help!

Lisa

[pcos_chick 23]

I had my sleeve performed on Oct 26th at Naval Medical Center Portsmouth by Dr. Mann. Someone else on this thread mentioned the program at NMCP. There are 3 or 4 surgeons who perform bariatric surgeries, but Dr. Mann is the only one who has performed or will perform a sleeve. He usually provides this surgery only as stage one of a two step surgery for those who are too heavy to safely undergo a bypass. I was convinced the sleeve was for me and he "caved" . The NUT, Psych, bariatric case manager, etc... all thought I didn't know what I was talking about when I said I was having a sleeve, that he hardly performs them and he certainly wouldn't perform one on me with a bmi of 40. I guess I "got lucky". Anyway, it IS possible to have a sleeve at Portsmouth. It's just very rare.

If anyone has any specific questions for me about my experience with Tricare, Dr. Mann or NCMP, I'm happy to help!

Lisa

Hey Lisa,

I'm set to have Dr. Mann as well... just got cleared by NUT and psych. I'm having the same experience with those at NMCP who don't seem to know much about the sleeve but everyone has been great so far. How was your surgery and post op experience at portsmouth?

[2BSkinny 0]

Hey Lisa,

I'm set to have Dr. Mann as well... just got cleared by NUT and psych. I'm having the same experience with those at NMCP who don't seem to know much about the sleeve but everyone has been great so far. How was your surgery and post op experience at portsmouth?

Hi. It's good to hear from a local! At NMCP you will be treated just as though you are having a bypass. Right down to signing all the consent forms that say RNY Bypass no fewer than 20 times. I took the time to cross each one off and handwrite sleeve above. Everyone I saw mentioned that I would be having a bypass and I had to correct people over and over again. Fortunately, Dr. Mann remembered I was having a sleeve. I think this was the last thing I spoke to him about before I was put to sleep. My medical card issued after surgery says that I've had a gastric bypass. I didn't bother crossing it out but don't be surprised if people fail to recognize the sleeve as an independent, DIFFERENT surgery from the bypass.

Dr. Mann is known to be a fantastic surgeon. He is the most experienced at NMCP and is known within the medical community, both civilian and military, as one of the best around. I felt comfortable with him and he did a good job. As of 10/26, the day of my surgery, he had never had a patient with a leak. I'm guessing he still hasn't, but this hasn't come up when I've seen him since then.

Here are some issues that I've had. First of all, the rooms are not private. I had a friend who recently had a bypass at Chesapeake Regional Med. Center and had a private room. You can have up to 3 roommates. In ICU I had one roommate who had family/friends in and out all day and night and had her tv on nearly full blast all night. I was very sick while I was there and thought I'd lose my mind with all the chaos and noise. After 18+ hours of enduring this misery, I politely asked the nurse if she could ask the lady on the other side of the curtain to turn her tv volumn down. She agreed and I finally managed to vomit blood and feel like I was dying in a little quieter environment.

I spent about 26-27 hours in ICU and was then moved to the regular floor. They only have 1 room for all bariatric patients and it has 4 beds. From what I understand they are usually full. I happened to get that room to myself and considered myself lucky. I never once turned on the tv, the noise really bothered me. Also, I couldn't focus my eyes on my books and magazines I brought. I was discharged about 76 hours after checking in and it couldn't have come soon enough. I spent nearly the entire time alone. My hubby had to take care of our kids and all their many activities near our home in VB, about an hour to 90 minutes away from the hospital depending on traffic. I'd recommend lining up someone to be with you much of the time. I would have loved to have had more help.

This should not be an issue for you but I wasn't given a post-op appointment until 3 weeks after surgery. That was entirely too long to wait. I had minor complications that could have been easily cleared up if I could have seen Dr. Mann earlier. He didn't have any openings during my weeks 1 and 2 post op and was on vacation during week 3. Like I said, this shouldn't happen to you but I suffered unnecessarily due to the exceptionally long wait.

Without going into details, I don't love the program there. My care has been good and I would definitely recommend Dr. Mann, though the program itself needs some work.

Best wishes to you! Keep me updated on your surgery and feel free to contact me if you have specific questions!

Lisa

[soldierzgirl36 0]

Hey, Im military wife and I saw phsyc before seeing the surgeon. My physc is in 2 weeks and then surgeon next. Went thru nutrition, both classes for that, then stress management, then goal settings, and occupational therapy. Now the physc appt then surgeon. Now for a few patients that are on alot of meds, they have to see a pharm tech, and get a pre op surgery consult appt also but I didnt have to do that.Hope all goes well for ya!

I had my first class on the 12th of Oct, am meeting with my nutritionist on the 19th of Oct, and then the nurse said I will be scheduling a visit with the doc...meanwhile I will have booked a Psych consult which is due after I see the Doc? Is this the usual course of events I am really praying to start my new life before the end of the year. If you are a military dependent and can share your experience, I am also having it done at a military base(per Tricare) I hope that goes well too. The surgeon seems to do these frequently but the military docs are so young that you get a little scared.

And...can you share with me some of the important things your asked the Doc because I am making a list, they told us to write down all of the questions and concerns before the appointment.

Thanks

[armyfamily4408 0]

Hi military wives I am at FT Hood and we do the VSG and I have my date on jan 13 super excited and super nervous its all worth the wait!!!