Question:
ATTENTION! all TRICARE people i need your help

i have looked in the library and i can't find some very important info. if you have tricare and had them pay for reconstructive surgery, what did you have to do. what info did you have to give them? did you have to have co-morbs(rashs ect.)? what hoops did they make you jump?lol i would really like to know how to go about this and i am sure your info would help ALOT of other people out also. you can also email me at [email protected] thanks!    — franbvan (posted on July 30, 2003)

July 30, 2003
I have my WLS in six days, and I have Tricare Prime, I asked a representative at Tricare Prime about reconstructive surgery. She told me that they go by medical necessity. They do not require you to be at goal weight, but they need documentation, such as pictures of rashes, amount of skin to be removed, and medical problems, such as back aches, and with a breast reduction neck problems, back aches, rashes, strap indentation. So they do approve panni/tt and breast reductions. I arms are a different story, unless you can prove medical necessity, you are on your own for your bat wings to be removed. What you have to do, is when you are ready, have your pcp put in a referral to a Plastic Surgeon for reconstructive surgery evaluation. Once you are approved for the consult and evaluation and visit the PS, you will have a better idea what Tricare will approve, the PS will know what Tricare approves and what they do not. The PS will know what codes to use, and they will put the referral into Tricare to get your surgery. Hope this helps.
   — cindy