TRICARE & Revisions

Found out yesterday afternoon that TRICARE instituted a "Once in a lifetime" clause regarding Bariatric surgery in August 2011.  Started my quest for revision to RNY in September.  Luckily, TRICARE is my secondary insurance AND I can appeal.  Yet another delay!!!

The lady that called me said she'd sent me the letter rejecting me, but she was so nice!  She told me not to panic and that I could appeal and talked with me about it for several minutes.  She was great. 

Just in case there are others like me that have TRICARE as an insurance, wanted to give you a heads-up.  Bummer!

If you are having complications, Tricare will cover another WLS.

Thanks for the info.  I'm glad to hear it!

Like what exactly? 

Thank you for the information!  I am seeing my surgeon today for revision surgery and Tricare is my only insurance.  When I called them they stated they would do a medical reveiw as some revisions are covered if medically necessary.  I have no idea if my issue is medically necessary at this point.  I've had an Upper GI done that shows my pouch to be quite large (it was large from the beginnng due to an issue with the doctor not being able to see past my liver) and I have stoma dilitation (streched and no food is staying in my pouch).  I am keeping my finger crossed that it will be covered as I have gained 28% of my weight back and have high blood pressure again, but am prepared to pay out of pocket if needed.  Please let me know the outcome of your appeal.  Best of luck!!

I will let you know.  I faxed my personal appeal letter to my surgeon's office today to be included in the appeal packet they're submitting.  According to my surgeon after doing an endoscopy, my staple line has come undone.  So basically, my VBG is no longer in existance.  Surely they'll reconsider.  Good luck on yours, too and keep me posted.

I had a RNY done in 2003 on post.  Now I am in need of a revision.  I have Tricare Prime Retire.  So I hope they will cover this.  What do I need to do to get the ball rolling.  Unfortunatly the doctor that I see now is all against any weightloss surgery period.  So for one, i have to find a new doctor.  And what exactly is the once in a lifetime clause.  Will they cover me if I do the switch or band instead?  Ugghhhh!  Good luck to you ladies.

Did tricare prime retired cover your revision?

I am trying to get my lapband removed and revised to RNY with Tricare standard.  I currently have been denied and we are starting the appeal process.  THe denial was due to once in a lifetime clause. 

I have had the lapband since may 08 and it has been problematic to say the least. 

All though it appears to only be slightly tipped I can not tolerate any fill at all.  I also vomit and have immense pain when eating foods that will encourage weightloss.  I am now on a liquid fast to help with that pain and encourage the weightloss I had hoped for. 

My Lapband was tilted and caused me a lot of problems. It eventually slipped so please be careful. Mine slipped so bad it strangulated my stomach and the band removed in an emergency surgery. Please just listen to your body, I am so glad I did. If I didn't get to my Surgeron when I did I could have died. I didn't know it could get that serious. I was the Case Study of the week for the surgical staff.

I believe Tricare will adventually consider your revision a "Takedown" and cover you. If not you could always go to a Military Treatment Facility and that circumvents Tricare almost completely. I'm in the process of trying to get into the program at Fort Gordon to get the VSG.

Best of wishes!