Tricare Prime Gastric Sleeve Surgery Coverage Progress

[gingersnap 11]

I've been following the Medicare approval process because as I understand it Tricare will not cover VSG until Medicare does. The Link Below is the supporting letter sent from American Society for Metabolic & Bariatric Surgery. Please if anyone learns any more about successful civilian Tricare coverage please share!!!

http://s3.amazonaws.com/publicASMBS/GuidelinesStatements/PositionStatement/ASMBS_CMS_Sleeve_Letter_Oct_28_2011.pdf

[Shae 44]

Is there an MTF in your area? If so, call to see if they have a bariatric department. If they say no then ask for general surgery to see if they have any bariatric surgeons. This is how I had to go about it here at Keesler AFB in Biloxi, MS. They don't have a bariatric department but they have bariatric surgeons. The MTF can do the sleeve without needing Tricare approval. I have Tricare Prime and got sleeved 10/19/11 at Keesler.

[tankerwife 2]

Any word on if they are covering the VGS now that they have made a bunch of changes with Tricare and WLS>??

[Shae 44]

I had my surgery at the hospital on base so it didn't go against my TriCare Prime. As far as I know they have not started covering it. You can also call and ask what type of weight loss surgery they do cover. Be careful how you ask because if you ask if they cover the sleeve, they will say yes. They cover gastric banding and sleeve plic...ation (cant remember what its called). Just let them tell you what they cover.

If there is a military treatment facility around you somewhere, you should check to see if they have a general surgery department where they might do the sleeve.

Good luck!

[gingersnap 11]

I'm not aware of any Tricare Changes that would allow Sleeve coverage. I'm in the Charleston, SC area and we do not have an MTF that I'm aware of. My surgeon at MUSC would do the Sleeve in a heart beat as soon as it's covered. I had to have my Lap Band removed in September and it would fall under Tricare to have another surgery covered without going through the previous qualifications of being 100+ lbs etc.

Please keep posting if you hear anything at all. I'm fighting so hard to keep my weight off but have already regained 35lbs since my band removal. I need the help of the sleeve ASAP to keep the weight off.

[tankerwife 2]

I will for sure!!! ANd you please do the same! I am wanting the sleeve and not near a MTF as well. Next year I will be near one, but was hoping to get it done before we had to move again.

[twoboysandagirl 109]

I am praying they begin to cover this...I too had the sleeve done by a general surgeon at a Balboa MTF. Could you travel to one? I think I have read of some one having travel several hours to a MTF.

[tankerwife 2]

I could travel, but I would not know where to begin to set it all up? Do you know how I would go about it.

[Shae 44]

Start by going online and searching out military treatment facilities that are close (relatively) to you. Get the numbers and call general surgery. Ask if they do the VSG there. If they say no, ask if they have a bariatric department and ask them the same. If you get a yes at an MTF, then the next step is to see your PCM and ask for a referral to that MTF's general surgery department (or bariatric department). Then, be sure to follow up with the MTF to ensure that they get your referral and ask them what the next steps are.

I hope this helps you...

[gingersnap 11]

Shae,

Thanks so much for your guidance. I have already a trusting relationship with my local weight loss surgeon and I'm holding out for Tricare to cover. But if we get a no them I'm going to have to try the MTF approach. March is just around the corner and I'm hoping to hear good news by then. Keeping my fingers crossed and trying not to gain anymore weight.

[BabyGirl2730 3]

Wow, am I understanding this correctly...Tricare doesn't cover the sleeve? I do know they do it on military bases, which is where I was banded but I have had SO many problems with my band that I was considering having it removed and going with the sleeve instead. Has anyone heard if it has been approved through a civilian provider yet?

[gingersnap 11]

Missy,

I completely understand having complications with the band. I started experiencing problems which resulted in a serious slip that almost strangulated and "killed" my stomach which would have resulted in death. I had no idea it could be that serious and I was teriffied afterwards. Since September I've gained almost 50 lbs back, and I'm so depressed that my band is gone and my fat self is coming back. I would have already had the Sleeve if it were approved. Now I'm back to hiding from the world and waiting for the Sleeve to be approved. My sister had the Sleeve 3years ago and has had amazing results even with some complications along the way. Good news is that she has not regreted having the surgery and highly recommends it for those who need it.

I've been following the Medicare approval process because as I understand it Tricare will not cover VSG until Medicare does. There should be some news at the end of March about Medicare so keep your fingers crossed that they approve it and get the ball rolling with Tricare.

But please if you have problems getting food and liquids down please see your surgern ASAP. It really could be life or death and the band is not worth the risk. Bands are having higher and higher complication rates and there are a lot of them being removed. Good luck and please keep me posted on how you do and what decision you make! I'll be praying for you!

[Jesusislove 26]

FYI Fort Jackson does the band, easy process if you are revising from band to sleeve, only have to see a NUT and Pre-op, upper GI, and Endo. Scheduled already for surgery.

Missy,

I completely understand having complications with the band. I started experiencing problems which resulted in a serious slip that almost strangulated and "killed" my stomach which would have resulted in death. I had no idea it could be that serious and I was teriffied afterwards. Since September I've gained almost 50 lbs back, and I'm so depressed that my band is gone and my fat self is coming back. I would have already had the Sleeve if it were approved. Now I'm back to hiding from the world and waiting for the Sleeve to be approved. My sister had the Sleeve 3years ago and has had amazing results even with some complications along the way. Good news is that she has not regreted having the surgery and highly recommends it for those who need it.

FYI Fort Jackson does the VSG

I've been following the Medicare approval process because as I understand it Tricare will not cover VSG until Medicare does. There should be some news at the end of March about Medicare so keep your fingers crossed that they approve it and get the ball rolling with Tricare.

But please if you have problems getting food and liquids down please see your surgern ASAP. It really could be life or death and the band is not worth the risk. Bands are having higher and higher complication rates and there are a lot of them being removed. Good luck and please keep me posted on how you do and what decision you make! I'll be praying for you!

[Anjelika 14]

I was told by the Tricare rep that my civilian PCP could not refer me to a MTF... is this correct?

[Jesusislove 26]

I was told by the Tricare rep that my civilian PCP could not refer me to a MTF... is this correct?

Are you all active duty or retired? If you are retired you do not have to go through tricare. However, if you are not retired, I would call the military treatment facility (the department that does the surgeries). I would ask them what I need to do in order to get an appointment with the surgeon. You may have talked to a rookie at Tricare, but call the hospital and they will give you clarity.