TriCare WLS Prerec Experiences?

[wifeaf 0]

Hi, all!

So, I'm a newly-married military wife, and I know that TriCare covers weight loss surgeries. I've read from a few topics on here (http://www.bariatricpal.com/topic/175096-tricare-now-covers-vsg/ for one, but there were some others) that mention that they cover gastric sleeve. I've already read the TriCare site, where it mentions the prerec of BMI/co-morbidities, but I want to know more about the process. I'm just curious what kind of experiences you've had with the whole shebang - what sort of tests and appointments did y'all have to go through before the surgery, was TriCare easy to work with, how much it cost, etc.
I'm new to this whole dealing with insurance thing, and since there's a lot of back and forth on the whole whether or not the sleeve is covered bit, I just thought I'd ask and see what the community reaction was.

Also, any info on gastric sleeve surgeries in/near the southern Illinois area would be extra cool. Thanks in advance!

Edited November 24, 2014 by wifeaf

[BitterSweet* 835]

The sleeve will be covered if it is done at a military facility that has a bariatric program. If you don't live near a post that has one, you'll have to get a referral from your PCP to a bariatric center, where you will have to follow whatever their protocols are; Tricare will only cover gastric bypass.

If there is a bariatric program at your post's hospital, you have to do the following to have a VSG:

-Get a referral from your PCP to the bariatric program.

-Attend the bariatric seminar, meet the surgeon and other members of the bariatric team (nutritionist, nurse, coordinating staff). You will be weighed and vitals taken which will be used to measure your progress and compliance.

-Attend their nutrition / weight loss program. One class is required, but continued participation is suggested.

-Maintain a food diary per the guidelines provided in the nutrition class (MyFitnessPal etc).

-Maintain or lose weight. Weight loss is not required, but you CAN NOT gain weight.

-Stop smoking. They will routinely check for cessastion via a urine test.

-Attend one bariatric support group meeting.

-Have a one-on-one session with the nutritionist who will check your food diary for compliance. Once cleared by the nutritionist, you'll be scheduled for a Psych appt.

-Get cleared by the psychiatrist (usually one appt, but more than one session may be required).

-After the psych clearance, an EGD will be scheduled to check for H. Pylori, hernias, and you may also have an ultrasound to check your gallbladder.

-Bloodwork is redone and if you see any specialists (cardiologist, pulmonologist etc), they'll need to clear you for surgery.

-Final meeting with surgeon. Surgery date scheduled.

-Length of time from beginning the program to having surgery varies. Could be a couple of months or closer to 6.

Hope this helps.

[wifeaf 0]

Wow, that was really helpful! It's also nice to know that I'm one step ahead by not being a smoker, lol. Thank you so much! So all in all, would you say that you had a good experiece with the whole process?

[laurenella82 625]

I used to work for the military medical system. One good thing to remember with them is that the military hospitals make their own rules. So if you call Tricare directly they may give you completely different information from what the base hospitals give you.

Be blessed!

[BitterSweet* 835]

Yes, the process is really not troublesome for most. The one issue (which is a biggie for me) is that the post where I am has only had their bariatric program for two years. The surgeon is well versed, has good bedside manner, and I trust him; however, he lacks experience.

Two years of bariatric experience is not very much, and he gets sent on TDY a lot, so there are significant periods of time that he isn't here operating on patients; he's done less than 200 surgeries. So, that bothers me enough that I am considering another option. I've gone through the program, the surgery is completely free, and the hospital is less than 5 minutes from my house... but, I'm strongly considering doing self pay and going to a bariatric center of excellence in MX.

[laurenella82 625]

Yes, the process is really not troublesome for most. The one issue (which is a biggie for me) is that the post where I am has only had their bariatric program for two years. The surgeon is well versed, has good bedside manner, and I trust him; however, he lacks experience.

Two years of bariatric experience is not very much, and he gets sent on TDY a lot, so there are significant periods of time that he isn't here operating on patients; he's done less than 200 surgeries. So, that bothers me enough that I am considering another option. I've gone through the program, the surgery is completely free, and the hospital is less than 5 minutes from my house... but, I'm strongly considering doing self pay and going to a bariatric center of excellence in MX.

And there's the real down side to surgery at a military hospital. If you can find a civilian surgeon working from a military hospital that may be better. I mean if you're gonna pay to travel maybe you can still get the surgery free.

[wifeaf 0]

Very good things to think about. Haven't gotten the orders yet - and we all know that it could change - but we're looking at heading to Scott AFB in Illinois, and the on-base hospital doesn't mention anything online about doing gastric sleeve, but they do have a bariatric program, so I hope to find out more when I get there. Thanks mucly for the well wishes, @@laurenella82.

@@BitterSweet* I've heard good things about the programs in MX! If it makes you more comfortable, then I say go for it. Gotta trust your gut about these bariatric surgeons, lol. Best wishes with whatever you choose!

[BitterSweet* 835]

Experience is everything when it really comes down to it. A non-reversible surgery where the majority of the stomach is removed needs to be in the hands of someone very skilled with years of experience and literally thousands of surgeries. Under the circumstances I really feel uncomfortable with a surgeon practicing on me.

@@laurenella82, Ikr that would be great.

[wifeaf 0]

@@BitterSweet* I 100% agree! While I know underexperienced surgeons need to practice... I don't want them doing it on me.

[BitterSweet* 835]

Exactly!

[ProjectMe 909]

Going through the military process now. It does differ depending on the base. My program required 3 nutrition classes, 3 support group meetings, psych evaluation, current mammogram, 0-2 comorbidities depending on your bmi, self referral process, that yucky test where you swallow the dye, colonoscopy if over 50 yrs old, 2 week preop liquid diet...and you cannot gain weight during this process.

Some think it's alot to go through. Personally, I've learned a lot about nutrition and the average weight loss for patients just going through this before process is 30lbs.

[Lindsey Skinner Abbott 97]

I currently live over seas in Germany. They just started a clinic up at LRMC. I met with the surgeon and really liked him. He seemed genuine. I am running into the same issue that he is not as experienced. Although he did tell me that he would keep me in the hospital 5 days and leave a drain in after surgery so if there is a leak he can go back in and the infection would not spill into my body. Now after reading your posts I am terrified of letting him do it. We do have the option to go to Frankfurt but the idea of not knowing languages terrifies me...I have to know what they are saying!

I met with my surgeon first then he referred me to the nutritionist. I have to have three apointments with her and cannot gain weight. They have not said anything to me about a psych visit.

[BitterSweet* 835]

Hey Lindsey, sorry if my post brought out terror vibes! That was certainly not my intent. I've watched videos of how a VSG is done and it really is not that difficult of a surgery. The stapling device is just genius so it seems like any surgeon could do a VSG.

My personal concern is that I have a hiatal hernia which will also have to be repaired, so that's really 2 surgeries in the same operation. Also, I have noticed that complications are glossed over too much. My surgeon said the same thing. It's a 3 day hospital stay and a drain is left in place until discharge, and that leaks are repaired with stents. Fixing a leak by placing a stent sounds as simple as getting an IV started, but it really isn't.

I purposely read the complications board on this forum. "Gastric Sleeve Complications Support Group". That is where you can find out what a leak or infection truly means and how immensely difficult they are to correct. Again, I do not wish to frighten you or anyone, but complications do happen. Some people are just unlucky, some people violate their post-op instructions and cause their own problems, and sometimes it's the surgeon.

I have the upmost respect and regard for military surgeons; I truly do, but these bariatric programs are new, which means their experience with performing these surgeries is also new and limited. My surgeon reported his leak rate between 1-2%, which apparently is about the national average; however, 1% for a surgeon that has done 10,000 sugeries is much different than a surgeon like mine who has done less than 200. That 2% looks mighty different in that frame of reference.

Btw, I lived in Mannheim for 3 years and I miss living in and touring Europe. Please stay in touch if you don't mind. Good luck in whatever you decide to do!

[Lindsey Skinner Abbott 97]

No problem Bittersweet! The surgeon here was very frank with me about what happens with a leak. He told me I would likely need to have a feeding tube to let the leak heal...if that didn't work then the stomach would have to be taken out! For that reason I felt comfortable as he was not just trying to get more surgeries under his belt so to speak! I actually work at LRMC and so I feel a bit better about care. He is just starting the clinic here and has only done more than 100 but less than 200....he hasn't had any complications yet but there is always the first one!

We have been here at Ramstein for 2.5 years and are moving to England in May! That was another reason I am choosing to do it here now. They send patients from England to LRMC for the surgery. We love living here in Germany!

[BitterSweet* 835]

Awesomeness! I'm so jealous of your pending move! I never made it to England or Greece but I pretty much went everywhere else. It was fantastic! Enjoy and stay in touch!