What do you know about Tricare/OHI coverage for VSG?

[Daydra 345]

Greetings All,

It appears that I have made the fatal error of deciding on this procedure before realizing that it isn't as easy to get covered. Both my Primary Health Insurance and Tricare cover bariatric surgery, but from what I'm reading, only RNY and LapBand, not VSG. I have read that there is some discussion that Tricare may cover in the near future with the advent of coverage by Medicare, but I don't want to wait for a decision on some unknown timeframe.

So, my question is this: Have any of you heard of getting authorization on VSG either through Tricare or another insurance carrier through some type of waiver process? I don't want to be funneled into a band, but I am unlikely to choose to pay out of pocket if the band is covered.

Thanks for any information or advice you can provide...

dd

[Allan Cameron 98]

Daydra,

I just had the sleeve in June at Madigan, since it is a Military Treatment Facility TriCare covered all of my costs, no out of pocket expense at all...just had to go thru the MAMC Education Pathway (took about three months) and then the surgery.

[Daydra 345]

Thank you for the update. I just had mine done at NWWLS in Everett. I'm 11 days out. I was discharged within 18 hours of surgery, no complications, very little discomfort, no nausea or vomiting. It's been super easy. I ended up paying out of pocket because my primary covers everything BUT sleeve and I was told that Tricare wouldn't cover it. I probably should have taken more time to research, but oh well. I didn't have to do the supervised diet and wait. Plus, I really didn't want to go to Madigan. About 8 years ago or so, I started the process of getting bypass done and I was really uncomfortable with the surgeon (treated me like I was looking for a magic pill) and I really haven't had good experiences at MTFs in general (Navy Hospital Bremerton and Branch Bangor), so I don't have a lot of trust in MTFs in general. (It's literally gotten to the point that I burst into tears during appointments if I'm in an MTF.) My primary insurance is covering some things that are related, we're just not sure yet of everything they will cover, billing is still in process. I took a loan to front the costs and I have a Health Reimbursement Arrangement through work that I had over $20k in, so I expect all my out of pocket costs will be reimbursed.

I hope that you have recovered nicely, and I wish you success! Looks like you are well on your way! Congratulations!