Tri Care said NO! But have other questions

[earlybroncogirl 1]

Don't chastise me on a public forum, you have a pm

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.

[Tiffykins 673]

Don't chastise me on a public forum, you have a pm

And, I've replied. There is no chastising in my reply. Simple questions, and asking for more details.

My biggest issue is that you are promoting a specific surgeon instead of sharing details on the approval process. You want to help, then promote the process not the surgeon for his way around the system. Insurance fraud has big consequences, and cheating the system has huge ramifications for all involved especially dependents. I have zero desire to pursue the "why/hows" behind this specific surgeon's tactics on getting it approved, BUT it's not fair to promote a specific surgeon without sharing details.

If you don't want to be questioned on a public forum, I suggest you pull the cloak and dagger thing behind closed/private messages.

[SKCUNNINGHAM 298]

Dr. Nicholson and Dr. Barker in Dallas are co-owners of the Park Forest MEdical Center - a hospital that specializes in Bariatric Surgery in Dallas, TX. Dr. Nicholson (my surgeon) gives a good deal to self-pay patients - particularly when you go to the Park Forest hospital. Both docs are very experienced Bariatric and sleeve surgeons. Dr. Nick's website is www.nicholsonclinic.com

[Lizbeth 16]

So my Dr. is going to submit my referral to Tricare to go to another MTF for surgery. I am praying this goes through. It is really frustrating that Tricare does not cover the VSG as it is less invasive and seems to have less side effects than a bypass. I really need to get this done. I really don't want a medical history like my parents and looking back I kinda wonder if my Mom had PCOS. With the health issues she had it kinda puts some things in perspective. I am hoping this goes right through and I can have this done before my husband deploys at the end of the year. So any prayers would be very much appreciated.....Hugs

[akt614 0]

_{Okay so it has been awhile since I was last on here... I have not given up hope on this!! I do have a concern about how far can a MTF be from your location to get a referral through?? Eglin AFB is the only one performing bariatric surgeries of any kind in Florida... and it is 8 hours away!! What are my odds on getting that through?? Or am I going to have to suck it up and wait for a transfer...}

_{Any help would be good! Thank you all so much for all the input!!!}

[Tiffykins 673]

_{Okay so it has been awhile since I was last on here... I have not given up hope on this!! I do have a concern about how far can a MTF be from your location to get a referral through?? Eglin AFB is the only one performing bariatric surgeries of any kind in Florida... and it is 8 hours away!! What are my odds on getting that through?? Or am I going to have to suck it up and wait for a transfer...}

_{Any help would be good! Thank you all so much for all the input!!!}

You should be able to get the referral. The issue is going to be getting the psych eval, nutritional consult and follow up covered and that Dr. Riley agrees to take on a patient who is not within a couple of hours. Last I heard is that Eglin is super backed up and Dr. Riley is the only VSG surgeon on Eglin at this time. He assisted Dr. Michel with my revision and is AWESOME.

I know of one patient that my surgeon (who is now at MacDill down in Tampa) accepted, but she was only in Panama City which is just 2 hours away from us here at Eglin AFB. She was a revision from band to VSG, and she was able to get the referral through her PCM and Dr. Michel performed her revision.

[akt614 0]

I just found out that Naval Hospital Jacksonville is performing Bariatric surgeries!! That makes me so much happier because it is only 3hours away... and as far as Eglin AFB- I called and said that their surgeon is transfering in June and they are not taking anymore patients, just finishing up with those they have already been dealing with. Confusing point.. Tricare whom I called today said that I need to contact the MTF and see if they have an opening, that they dont deal with referrals to MTF's... But then when I called the Naval Hospital in Jacksonville- the man said I need to have my PCM refer me to them through TRICARE.. soo I am off to the DR, in hopes of a correctly worded refferal to the MTF in Jacksonville!!

[Tiffykins 673]

Awesome ! ! ! Hope everything goes through. . . I knew Dr. Riley was leaving this year sometime as he was my assisting surgeon on my revision and Dr. Michel told me that Dr. R was leaving as well.

It really sucks because I have a friend looking into VSG and she's hitting roadblocks too.

[Jesusislove 26]

Hi, Fort Jackson does the sleeve as well, pretty quick process if you are revising, did not have to go throug Tricare. Surgery is very soon.

[ReeTee 14]

Killeen texas

[onmywaytx 3]

Where in Texas are you? I'm in Corpus' date=' and my surgeon is Dr. Nilesh Patel in San Antonio. Self-pay for everything is 14,000.[/quote']

Does he offer any type of payment plan?

[earlybroncogirl 1]

I am in NC and have tricare standard~~Dr T. Ryan Heider in Mooresville did my VSG~~Tricare approved~~I know I will get somme haters remarks on this, but those are the facts..I have nothing to gain sharing this with you~~Good Luck

[mrsflyboybs 62]

Hello! I was sleeved at Travis AFB on 4/16/12. It took me eight months to get through the process. (sleep study, NUT, psych , echocardiogram , EKG, endoscopy, colonscopy , blood work, blah blah blah). My dr does all three types of surgery, I chose lap band but he suggested the sleeve instead. I never had any issues with tricare. I was 100 lbs overweight and my bmi was 40 no pre existing conditions. I'm sorry tricare is being jerks, I hope my story can help you push your case. Good luck!

[Tiffykins 673]

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

No out of pocket expense at all.

[Tiffykins 673]

I am in NC and have tricare standard~~Dr T. Ryan Heider in Mooresville did my VSG~~Tricare approved~~I know I will get somme haters remarks on this, but those are the facts..I have nothing to gain sharing this with you~~Good Luck

Can you share how you got it covered and what code he used to get it covered since you're in the South region of Tricare as well?

The reason I'm asking is because our MTF is no longer offering bariatrics as the surgeons have both been PCS'd. So, now everyone is getting referred off base, and getting denied since Tricare has NOT picked it up here.

They've gone through the requirements, they meet the guidelines and they are still getting denied and ONLY approved for the band or bypass.

No hate, just if it's getting approved, it would be helpful to other dependents if you could share some details to help others.