Tricare and abdomnioplasty

[Mary23 17]

Has anyone been approved?

[HappygoSusan 296]

Hi

I am on Tricare prime and had a Tummy Tuck in May. My procedure was done at a MTF by the same surgeon that did my sleeve. It is my understanding that by using the MTF, it is not actually paid for by Tricare, so I am not sure what is involved in getting a referral to a PS and approved for the surgery. I hope you can get some more informed responses to your post. Good luck, Susan

[Katcloudshepherd 630]

Hi

I am on Tricare prime and had a Tummy Tuck in May. My procedure was done at a MTF by the same surgeon that did my sleeve. It is my understanding that by using the MTF, it is not actually paid for by Tricare, so I am not sure what is involved in getting a referral to a PS and approved for the surgery. I hope you can get some more informed responses to your post. Good luck, Susan

Is your primary care doctor through Tricare prime? I have insurance through my employer and see a civilian doctor. I am covered under my husband's Tricare prime but it is secondary to my insurance and rarely pays for anything. Any advice would be greatly appreciated.

[HappygoSusan 296]

My PCM is actually in the MTF. I asked tonight at my support group and was told that you can use a MTF if Tricare prime is your secondary insurance. They will just bill your primary first and then bill Tricare for any remainder. If you are near a MTF, just call general surgery and see if they do tummy tucks there. If so, I'm sure they can tell you what you need to do to get a referral. Have you already seen a Civilian PS? My original referral was to a civilian surgeon for WLS, but I wanted the sleeve and that wasn't covered by Tricare . It was however an option at the MTF. I called general surgery directly to find out why I was sent yo them , they checked my records , saw no reason why I shouldn't be seen there and just took over my referral. Once i was in their system, the surgeon there has been in charge of my WLS care and follow up care, including approving me for the Tummy Tuck at that facility.

[Mary23 17]

My PCM is actually in the MTF. I asked tonight at my support group and was told that you can use a MTF if Tricare prime is your secondary insurance. They will just bill your primary first and then bill Tricare for any remainder. If you are near a MTF, just call general surgery and see if they do tummy tucks there. If so, I'm sure they can tell you what you need to do to get a referral. Have you already seen a Civilian PS? My original referral was to a civilian surgeon for WLS, but I wanted the sleeve and that wasn't covered by Tricare . It was however an option at the MTF. I called general surgery directly to find out why I was sent yo them , they checked my records , saw no reason why I shouldn't be seen there and just took over my referral. Once i was in their system, the surgeon there has been in charge of my WLS care and follow up care, including approving me for the Tummy Tuck at that facility.

Our facility doesn't have a surgical unit....I had a consult with a civilian doc who was great but doesn't think we will have much success in getting payment....thinking if anything they may cover just the skin removal. I have my fingers crossed!

[HappygoSusan 296]

Have you checked the Tricare website to confirm what they will cover and what needs to be documented for authorization? Print off a copy and take it to PS before he submits your paperwork.

[Mary23 17]

Have you checked the Tricare website to confirm what they will cover and what needs to be documented for authorization? Print off a copy and take it to PS before he submits your paperwork.

Yes I was given the guide and spelled out what needed to be in print...I am keeping my fingers crossed

[Mary23 17]

On to find a new doc all because the current one has an awful office staff

[HappygoSusan 296]

How's the search going?

[Mary23 17]

Just starting the new process.....question though, I'm sure you probably heard this before but I truly am in this for the skin removal......do you think it would be silly to do just a panniculectomy and not the full abdomnioplasty ?

[HappygoSusan 296]

I've not seen anything but the results of a Tummy Tuck. If Tricare covers a full tummy tuck I certainly would go with that. The recuperation from the tummy tuck isn't bad, and the results are worth it. Have you looked online for pictures to compare the difference. What are your concerns? Pain? Recuperation? Scarring? My scar does run from hip to hip, but it is completely covered by bikini panties. I never even used the prescribed pain medication after leaving the hospital, and I'm not sure that the recuperation time is any less for just the skin removal. I would think your PS will be able to tell you which will give you the best results.

Best wishes

[Mary23 17]

Thank you Susan.....according to the PS around here they are two different things...panniculectomy just removes the skin and in cases Tricare has approved it. Tightening of the muscles is cosmetic and not covered so in essence they will do the whole thing at their price and deduct what Tricare will pay for the panniculectomy from the total. ( they say it's less than a quarter of the overall price) I'm in the process of getting a second opinion so we will see if changes from doc to doc. The trick now will be finding a doc I am comfortable with.

[HappygoSusan 296]

Thank you Susan.....according to the PS around here they are two different things...panniculectomy just removes the skin and in cases Tricare has approved it. Tightening of the muscles is cosmetic and not covered so in essence they will do the whole thing at their price and deduct what Tricare will pay for the panniculectomy from the total. ( they say it's less than a quarter of the overall price) I'm in the process of getting a second opinion so we will see if changes from doc to doc. The trick now will be finding a doc I am comfortable with.

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I didn't realize Tricare did not cover the full Tummy Tuck. I have read on this site that a lot of insurance companies only cover the panni, so that most either only get that or pay the difference. Have you conferred with your WL surgeon to see if they recommend a PS?

[Mary23 17]

Yes, I have but it's a personal feeling so I will search until I find the right one! I wish my weightloss surgeon could do it!

[HappygoSusan 296]

I know what you mean. It's a big deal to trust somebody with your body and life ! Keep searching until you feel it's right for you.