Tri Care said NO! But have other questions

[Tiffykins 673]

Thank you for this information!! I think MacDill will be closer than Ft. Gordon Army Base. I did call the Tricare office at Patricks and she was very helpful in telling me what Ill need to do. Since I have a civillian PCM id have to first switch over to a PCM AT patricks, then go through the referral process to be switched to another MTF that offers the VSG! Im so happy that I was able to find out.. I really want to go through with the surgery but did NOT want to settle with the band or gastric bypass... I am so thankful I found this site!!!

I just thought I'd throw it out there that I have a civilian PCM and did not have to change to an on base/post PCM to get the referral to the base bariatric department. I hope things go smoothly for you, and best wishes on your journey ! ! !

[akt614 0]

When I contacted Tricare they informed me that if the MTF near you does NOT do the VSG they can transfer you to another MTF that DOES the VSG.. Its easy for them to transfer MTF to MTF.

I was told by tricare yesterday you could get approved with a civilian provider if your mtf does not do the procedure. I have an appt. tomorrow with my pcm to try and get a referral for the vsg. I am almost 100 lbs overweight have pcos, high cholesterol and some joint pain. I was told by a friend who had a vsg via tricare that I should qualify for the surgery with no problem. Hoping it goes well. I will keep you all posted on my journey.

[akt614 0]

I think I will have to because Patricks does not offer it, so Id actually have to be transfered to an MTF that does the procedure.. I think thats how the lady worded it..

I just thought I'd throw it out there that I have a civilian PCM and did not have to change to an on base/post PCM to get the referral to the base bariatric department. I hope things go smoothly for you, and best wishes on your journey ! ! !

[akt614 0]

did you have any out of pocket expenses when it was done at an MTF?

[Lizbeth 16]

When I contacted Tricare they informed me that if the MTF near you does NOT do the VSG they can transfer you to another MTF that DOES the VSG.. Its easy for them to transfer MTF to MTF.

O.k. so frusrated. I called tricare back with the cpt code (43775) for the vsg surgery once again to see if what they said earlier was true and nope they were wrong. Its not covered unless done at an mtf. My mtf does not do it so I have to find one close to me to see if they do it. I live in Phenix City, Alabama stationed at Fort Benning, Georgia so if anyone knows a close mtf that offers this pleases share!!! The man on the phone told me tricare has nothing to do with the mtf as they dont file claims with tricare so he couldn't tell me if I could have the surgery at another mtf and how to go about doing that.....grrrr So this puts yet another stall in the process! HELP!!!!!!!!!!!!!!

[lyn 5]

You need to call the bariatric clinic at BAMC you do not need to go to your PCM for a referral. I had my sleeve done there and I am sure you could get all the information and come down for your appts. The only trouble would be the nutrition classes but I am sure you could go to classes in Killeen and they would count. Bythe way they just changed it here at Brooks Army Medical Center (BAMC) where you only need 3 months of classes instead of 6 months, very cool. All of your blood work can be done at any other military facility and the results are sent over to the clinic.

They require you to first go to a informational meeting and then to a surgery specific meeting. Then you start checking of the squares you sleep test, pschy eval, and all the rest. I would call them. I had a BMI of 39 and was sleeved in April.

their numbers are 210-916-9023 or 210-916-0763

good luck!!

[Lizbeth 16]

I just thought I'd throw it out there that I have a civilian PCM and did not have to change to an on base/post PCM to get the referral to the base bariatric department. I hope things go smoothly for you, and best wishes on your journey ! ! !

So I don't have to change to a base pcm. I have a civilian pcm but my mtf doesnt offer the surgery. How do I get to be referred to another mtf for this? The closest one being Fort Gordon about 4hrs away. Is it even possible to do that? Help please....

[lyn 5]

So I don't have to change to a base pcm. I have a civilian pcm but my mtf doesnt offer the surgery. How do I get to be referred to another mtf for this? The closest one being Fort Gordon about 4hrs away. Is it even possible to do that? Help please....

I would call Fort Gordon and see if they have a bariatric clinic and see what their procedure is. BAMC did not require my PCM referral, which saves a ton of time and questions. Good Luck

[Lizbeth 16]

I would call Fort Gordon and see if they have a bariatric clinic and see what their procedure is. BAMC did not require my PCM referral, which saves a ton of time and questions. Good Luck

Thanks, I called Fort Gordon and they said my pcm has to send a referral to tricare for fort gordon. This makes no sense to me!

[Lizbeth 16]

Can anyone tell me what hoops I will have to jump through to have this done at an mtf. I kinda want a rough time table from start of process to finish. My bmi is 38.1....I have high cholesterol, pcos and hip and back pain. I am about 100 lbs overweight depending on what charts you look at. Was hoping that the process didnt take to long since the hubby will be deploying towards the end of the year, I would like to have it done before he goes.

[Tiffykins 673]

did you have any out of pocket expenses when it was done at an MTF?

No, there are zero out of pocket costs at MTF.

[Tiffykins 673]

Can anyone tell me what hoops I will have to jump through to have this done at an mtf. I kinda want a rough time table from start of process to finish. My bmi is 38.1....I have high cholesterol, pcos and hip and back pain. I am about 100 lbs overweight depending on what charts you look at. Was hoping that the process didnt take to long since the hubby will be deploying towards the end of the year, I would like to have it done before he goes.

It varies by facility. Here at Eglin, my revision took 3 months to get done, and I did NOT have to jump through any of the normal hoops, like the psych or nut evals. However, I had to have more labs done, and had to get some extra stuff done due to being a revision.

I've seen other MTFs require these appointments, the basic seem to be(marked with an * are ones I had to do as a revision) : Labs*, eKg*, endoscopy (I did not have this one), psych and nut eval, chest xray*, informational seminar (typically the very first appointment). Some require a manometry (up in the Northern region is the only place I've read about this requirement. In the Pacific NW (Oregon, Washington area MTFs) they require a 6 month supervised diet/weigh in, with multiple nut visits, but that could have changed.

With my band, I had a civilian place it and it was covered by Tricare Prime 100% with zero out of pocket. I had a psych eval, 3 nut visits, labs, chest xray, eKg, psych eval.

I'm really sorry that you are having to go through all of this Heather. I am not surprised that Tricare isn't picking up the VSG(as we've heard they were going to do so since 2009, 1 October comes and goes without changes in their bariatric profile of approved surgeries) since Medicare is still NOT fully covering it with all of their plans.

[Tiffykins 673]

So I don't have to change to a base pcm. I have a civilian pcm but my mtf doesnt offer the surgery. How do I get to be referred to another mtf for this? The closest one being Fort Gordon about 4hrs away. Is it even possible to do that? Help please....

It is possible to do, HOWEVER, your PCM will have to put in the referral specifically to that MTF. I have a civilian PCM, and I get kicked to civilians for everything. I have 2 friends who see the same PCM, we all got referrals to Eglin AFB without issue. So, your PCM has to put it in correctly. Grant it, we aren't dealing with the distance issue since Eglin is a neighboring base for us here, but I know several people who get referrals for distant MTF for the VSG. BUT, it is at the discretion of that MTF to take you as a patient, they do NOT have to take you, they can say that you will not be able to have the required follow up. HOWEVER, your closest MTF and PCM can do your labs, and handle any aftercare. You just have to have your PCM on board.

[earlybroncogirl 1]

Heather, contact Dr T.Ryan Heider thru his website regarding Tricare approval and what you want. I don't want to go into it, but I think you will find your answers there.

O.k. so frusrated. I called tricare back with the cpt code (43775) for the vsg surgery once again to see if what they said earlier was true and nope they were wrong. Its not covered unless done at an mtf. My mtf does not do it so I have to find one close to me to see if they do it. I live in Phenix City, Alabama stationed at Fort Benning, Georgia so if anyone knows a close mtf that offers this pleases share!!! The man on the phone told me tricare has nothing to do with the mtf as they dont file claims with tricare so he couldn't tell me if I could have the surgery at another mtf and how to go about doing that.....grrrr So this puts yet another stall in the process! HELP!!!!!!!!!!!!!!

[Tiffykins 673]

Heather, contact Dr T.Ryan Heider thru his website regarding Tricare approval and what you want. I don't want to go into it, but I think you will find your answers there.

So, is there a process that you are aware of that could help 100s of other military spouses to get approval for VSG with a civilian surgeon???

If you have this information, please share it. I don't care how it gets approved, but if you can share details, you would helping a huge amount of wives that are settling for RNY, the band or staying FAT for the rest of their lives.