Wife wants to get VSG

[frenchinja112 0]

I am active duty stationed overseas but my wife lives in Kennewick,Wa. She wants to get VSG but I have no idea if Tricare Prime covers it or not. I've been reading many forums and I'm getting mixed messages. Most say that tricare doesn't cover it and some say they only cover it at certain MTFs. If they do cover it what is our cost out of pocket? If they don't cover it does anybody know any good locations for us to get her surgery out of pocket? So far I've found hospitals in Mexico.

[myrori 55]

My daughter has tri care west and they covered her for the Gastric bypass, I would say just call a doctor in the area who does the surgery and ask about your insurance. The doctors office KNOWS who and who does not cover what, thats their paycheck!

[Tiffykins 672]

Yep, they'll cover it at any military treatment facility. Madigan offers the sleeve, she'll just need to get a bariatric referral from her PCM. Schedule it with Madigan and go through their program. It is a process as with everything with Tricare, and if she has any specific questions, please feel free to contact me. I know there are a couple of other military spouses on this forum that have had their VSG performed at Madigan with great success. Hopefully, they will chime in here soon !

If Madigan is not an option, check with these MTFs.

http://www.tricare.mil/mtf/main1.aspx

There will be no out of pocket if you go through the MTF, it is NOT covered with civilian surgeons, and you would be responsible for all of the fees. Also, any labs, procedures, follow up care would not be covered since the VSG is not a covered service approved by Tricare Prime or Standard.

I've ran the gamut with Tricare in all the regions and have even helped a friend file a congressional complaint. VSG will not be covered by Tricare until Medicare fully picks VSG as a covered procedure without any additional pre-requirements that are listed for bariatric approval.

[frenchinja112 0]

Wow ok so to get the ball rolling I should have my wife call her PCM and get a bariatric referral? Does she just call and specifically request that or something? I'm completey new to tricare. I didn't even know about Madigan so thank you so much for that. That is perfect for us. Approximatively how long does it take from get the bariatric referral to getting the surgery?

[myrori 55]

From the time my daughter got the referral to surgery was 4 months.

[frenchinja112 0]

Ok my wife is scared and nervous she doesn't know what to say to her PCM. I told her to say that she is new to tricare and would like a bariatric referral. That's what she should do right?

[myrori 55]

Most likely your wife will need to make an appointment and ask for the referral. She should never be embarrassed to speak to her doctor about a condition about her health. The doctor will have to see her and make notes in her chart as to the physical needs she has that would require her referral.

[frenchinja112 0]

Most likely your wife will need to make an appointment and ask for the referal. She should never be embarraed to speak to her doctor about a condition about her health. The doctor woll have to see her and make notrs in her chart as to the physical needs ske has that would rqiure her referal.

Thank you. She's really nervous about getting the surgery and she's even more nervous because she thinks I won't be there with her but I'm going to take leave and surprise her once we get a set date.

[myrori 55]

Do whatever it tales to calm her nerves now, just remember from the time you get the referral and then see the surgeons there will be tests to pass at others doctors offices, there is a psych eval, a sleep study, a pulmonolgist visit and then you get a date providing all clearances are passed.

[sasicas 194]

As its already been said yes Tricare will cover bariatric surgery.

She needs to see her PCM and just request a referal for bariatric surgery. If she meets the BMI requirements there should be nothing in her way of getting the referal. Bariatric services will then call her once its approved and she will go to the orientation that is held once per month. At that orientation she will get a number on the wait list. Once her number comes up she will get a call to start the Pathways program.

Pathways includes an appt with the case manager. She puts in the referals for the other appts. The next appts are a physical (which she could easily just go in for a physical to begin with to get the referal for bariatric surgery and get it over with before starting pathways), two nutrition appts, a goal setting class, a stress management class, attending a support group meeting, and an occupational therapy appt. After those she will call the case manager again. She will put in the referals then for the pysch eval, a surgery clearance appt, and any other appts for specialty doctors she might have. After that she will see the surgeon and surgury is usually a month after that. The hospital stay is 2 1/2 days for the VSG.

Once on the Pathways, they say the appts should be over and done with in a month, so its a pretty quick process as far as the military is concerned

[Susanne 32]

Holy cow - I thought my process was taking long, but compared to this is seems like it went fast (9/18 - Intro Seminar, 11/2 Surgery).

Good luck to you and your wife -- btw, why isn't she asking herself? Bring her in...

[Tiffykins 672]

It doesn't always take forever. I've had friends go to the information seminar, get their labs, psych consult done, and first nutritional class completed then BAM consult and surgery was a week to 2 weeks later total process time was 6 weeks.

Also, the only pre-op tests were labs, chest xray, ekg, and I had special labs done with an oncologist due to a clotting disorder. I never had to do stress test, pulmonary consult, or any other additional tests because I had no co-morbidities, not even HBP or cholesterol.

Is your wife stateside? I'll send you a message with my phone, or have her add me on Facebook(link is my signature below), I can help her with all the ins and outs of Tricare. I'm also an insurance agent so I'm well-versed on how all of this process works.