TRICARE and band revision to VGSleeve

[Mimilou2004 13]

I would appreciate anyone posting who has knowledge of Tricare paying for the Sleeve after the band needed to be removed.

Thank You,

Mimi

[Dave_NW 92]

I would appreciate anyone posting who has knowledge of Tricare paying for the Sleeve after the band needed to be removed.

Thank You,

Mimi

To my knowledge, Tricare will only pay for sleeve surgery if it's done at a military hospital. I originally was going to have sleeve surgery, but was told they wouldn't pay for it if I was using an off-base surgeon. Because of my location, I elected to have lap band instead (which WAS covered off-base.)

As for paying for a second surgery, the following is taken from the Tricare website:

"TRICARE covers gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery) is covered only when the beneficiary meets one of the following conditions:

• Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints
• Is 200 percent or more over ideal weight for height and bone structure
• Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown) "

The key phrase is the third bullet, "because of complications, requires another surgery." That says to me they will pay for a second surgery, if complications require it.

Your best bet is to contact Tricare and ask them directly. The rules change every so often, and their website may not have the latest information.

Hope this helps. Good luck!

Dave

[Mimilou2004 13]

Thanks, Dave, I appreciate your posting. When I read the above I wanted to believe if I slip again they will pay for the sleeve!

Mimi

[lumbee 1]

Mimi..me too...if you find anythng out please let me know as well.

I would appreciate anyone posting who has knowledge of Tricare paying for the Sleeve after the band needed to be removed.

Thank You,

Mimi

[AliOneTrackizTheBizness 0]

I have tricare and just had a band to gastric bypass revision last month. I was told that the sleeve was not covered at all, and was not an option

[Mimilou2004 13]

I was afraid of that and when I reread the standard it was pretty clear that Sleeve would not be an option. I am sorry you lost your band, I don't know if I could be as brave as you and get the bypass at my age (basically 60). Thanks for responding,

Mimi

[Divamom 1]

Mimi My mom is 68 and had the sleeve done at Wilford Hall in San antonio...they now want to go back in and change it to Gastric bypass...I think you should just go all the way and have bypass...I am having my Lap band out (thank God!!!!) on May 23rd and having bypass and the other person who posted is correct, Tricare will not pay for Sleeve but my doc did say he has had luck that if for some reason they get in there and are unable to do bypass for some reason and then perform the sleeve Tricare has covered it but I am not gonna take that chance since my band failed me. I don't want to get the sleeve and then a year or 2 later the doc say oh let's do the bypass...I am 40 and have lost 3 yrs of my life to the band and have only a 12 lb loss. So pissed off, not to mention the pain, discomfort and vomitting. Just be sure whatever you do...I wish I would have done bypass to begin with. Good luck!!!!!

[Mimilou2004 13]

Hi, Leah, thank you for posting....ignore my question on your other post as you just answered it wonderfully. Your information was spot on and I appreciate it. I am so worried about being obese again!!!! I was 125.1 this morning and wonder if they would still do the bypass if my band slips again? I am babying it like crazy.....not with slider food, but by not pushing the quantity of food I eat at one time.

Mimi

[Dave_NW 92]

I think there may be some confusion here. Tricare Prime WILL pay for the sleeve, if it's done at a military hospital. They WON'T pay for the sleeve at a civilian facility. At least that's how they do it here in Washington state. When I started this I could have had the sleeve done, if I wanted to wait for an opening at Madigan Army Hospital. It would have been several months' wait, and I don't live near Madigan, so I opted not to wait, and I had band surgery in Seattle instead.

So before you commit to a surgery you don't necessarily want, be sure to check out all your options.

Dave

[laura lee5724 0]

I HAD MY REALIZE BAND MARCH 2008 AND LOST 60 POUNDS SO FAR. i HAD A Tummy Tuck jAN 2010. EVERY SINCE THE TUMMY TUCK MY PORT STICKS OUT AND i HAVE SCAR TISSUE AROUND IT. (I THINK) nOW i HAVE NOT HAD ANY RESTRICTION EATING SINCE THE TUMMY TUCK! I HAD AN ENDOSCOPY AND A BARIUM TEST LAST MONTH, BOTH WERE FINE. TODAY i HAVE A FLOUROSCOPIC FILL AT HOSPITOL. DOC HOPING TO FIND A LEAK IN PORT OF TUBING LEADING TO THE BAND. I AM SOOOOO UPSET. LOST NOTHING FOR A YEAR. EVEN UP 12 POUNDS. SO I HOPE TO GET ANSWERS TODAY!!!

[laura lee5724 0]

I HAD MY REALIZE BAND MARCH 2008 AND LOST 60 POUNDS SO FAR. i HAD A Tummy Tuck jAN 2010. EVERY SINCE THE TUMMY TUCK MY PORT STICKS OUT AND i HAVE SCAR TISSUE AROUND IT. (I THINK) nOW i HAVE NOT HAD ANY RESTRICTION EATING SINCE THE TUMMY TUCK! I HAD AN ENDOSCOPY AND A BARIUM TEST LAST MONTH, BOTH WERE FINE. TODAY i HAVE A FLOUROSCOPIC FILL AT HOSPITOL. DOC HOPING TO FIND A LEAK IN PORT OF TUBING LEADING TO THE BAND. I AM SOOOOO UPSET. LOST NOTHING FOR A YEAR. EVEN UP 12 POUNDS. SO I HOPE TO GET ANSWERS TODAY!!!

i WANT TO GET A REVSION TO BYPASS. SURGEON SAID HE WOULD DO IT IF HE COULD FIND SOMETHING WRONG WITH MY BAND.

[BabyGirl2730 3]

Thank You all so much for this info!! I have looked everywhere to find out how to go from the band to the sleeve. I was banded in July 2010 at Ft. Lewis, WA and since then have only lost 52 pounds. I have had so many issues with the band and most of my weight loss has come from it starving me to the point I couldn't get Fluid down even ended up in the ER a few times. I vomit ALL the time usually with every meal, I'm lucky if I can get down a couple spoon fulls not to mention the blood that I have been vomitting up. I finally had to have ALL my fluid taken out and still have these issues even after the fluid has been out for about 5 months. I really wish I would have taken my surgeons advice and gone with the sleeve to begin with. I see a off post surgeon because they don't have anyone at the base I am at that will even touch me becuase there is no one that is certified in this field here and was hoping to get approved to have the band removed and the sleeve done in it's place. Please keep me posted if anyone gets any news and is able to have this approved!!

[xavier 153]

My doc sewed my band in place and he has never had a single patient have a slip or an erosion. I have thrown up more than I want to admit but that band is going nowhere...why wouldnt a doc sew it down in the first place or at least sew it down when it is put back in place after a slip?