I'm at the very beginning of my journey to a possible VSG. My husband is active duty Army and we have Tricare Prime insurance. The Tricare website says that they cover gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery). Would I be correct in assuming that VSG would be the same as vertical banded gastroplasty or gastric stapling??

I have yet to contact my PCM and discuss referral options in my area, so I'm literally at the VERY BEGINNING, but I thought this would be a good place to start asking questions.

Thanks in advance!

Unless the DR is coding it differently, it's not being approved with Standard or Prime.

Here's my challenge: If there's anyone out there that claims their VSG was approved OUTSIDE an MTF with Tricare, please call your Dr and find out what code he used for that approval. That would help alot.

Just visited my surgeon today and they called the TriCare rep with the code today and it is not covered by TriCare Prime at this time and God only knows when they will get around to it. So LapBand here I come...

I have tricare prime and I'm getting it approved. I have a PCM at an Air Force base who has referred me to a civilian surgeon. He says no prob!

I'm at the very beginning of my journey to a possible VSG. My husband is active duty Army and we have Tricare Prime insurance. The Tricare website says that they cover gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery). Would I be correct in assuming that VSG would be the same as vertical banded gastroplasty or gastric stapling??

I have yet to contact my PCM and discuss referral options in my area, so I'm literally at the VERY BEGINNING, but I thought this would be a good place to start asking questions.

Thanks in advance!

I have tricare prime and I'm getting it approved. I have a PCM at an Air Force base who has referred me to a civilian surgeon. He says no prob!

Is it already approved or did your doctor just say to you it wouldn't be a problem? If it is already approved can you find out what code they used?

I have tricare prime and I'm getting it approved. I have a PCM at an Air Force base who has referred me to a civilian surgeon. He says no prob!

If you can get an ICD-9 code, I would really appreciate it. We have 2 military wives on the board right now fighting to get coverage with civilians so this information would be extremely helpful.

I had 4 surgeons tell me "NO problem", submitted the paperwork, got denials even as a revision patient. Like I said, I've had friends appeal, peer to peer reviews, and file congressional complaints to get coverage for a sleeve with a civilian so if you actually get it, please share how on God's green Earth, this civilian surgeon is working the system to get them approved by Tricare Prime.

PLEASE MAKE IT FAST! BECAUSE SOME OF US ARE ABOUT TO SELF PAY WITHIN THE NEXT 3 MOS. AND THAT INFO COULD SAVE US THOUSANDS!!!

PLEASE MAKE IT FAST! BECAUSE SOME OF US ARE ABOUT TO SELF PAY WITHIN THE NEXT 3 MOS. AND THAT INFO COULD SAVE US THOUSANDS!!!

If you end up self-paying, save every receipt. Even for travel, prescriptions, meals out, supplements, every single receipt because when/if they ever do start covering it, they MIGHT, retroactively reimburse you for it like they did for the band.

I called again today, and it's still NOT a covered a procedure, and I spoke with a claims manager here for Tricare South, and I called Tricare West as well. I confirmed again that all the ICD-9 codes for gastrectomies for weight loss are not covered by Tricare Prime outside of MTFs, and it is NOT a covered procedure with Tricare Standard or Tricare for Life.

THANKS FOR THE INFO TIFFYKINS I WILL REMEMBER TO DO THAT!

I'll probably speak with them next week (they are in another town). The Tech that handels the insurance and put my package together said they do tricare all the time. I asked because I keep hearing on these forums that it would not be approved. They said no prob, they do it all the time. As a matter of fact 3 of my friends have already had it done.

Is it already approved or did your doctor just say to you it wouldn't be a problem? If it is already approved can you find out what code they used?

I'll probably speak with them next week (they are in another town). The Tech that handels the insurance and put my package together said they do tricare all the time. I asked because I keep hearing on these forums that it would not be approved. They said no prob, they do it all the time. As a matter of fact 3 of my friends have already had it done.

By a civilan doctor in a civilan hosptial? If it's an MTF yeah then it's covered but like Tiffykins just posted she even just called Tricare and it's not a covered procedure! They do cover Bypass and Band though!

I have medicare and tricare for life cause i am disabled(legally blind) my husband active duty and i go on post and i was also told that is the only place they would cover the vsg. I am in the begining stages but all i need is a support group meeting, psych eval, and the seminar then i will get on the waiting list then it could take any where from a month to a year.

I'll probably speak with them next week (they are in another town). The Tech that handels the insurance and put my package together said they do tricare all the time. I asked because I keep hearing on these forums that it would not be approved. They said no prob, they do it all the time. As a matter of fact 3 of my friends have already had it done.

Is it by a civilian surgeon off post/base?

Kassie- Hi! I am excited for you even in the research stage, what the other wives have said is accurate, I've been an Air Force wife for a little over 12 years and at our last duty station where I still had not heard about the sleeve I was looking into the lap band, and THANK GOD did not go through with it but they told me that my primary needed to make a letter to tricare stating I had tried dieting and blah blah and then I would wait for approval and blah blah-point is, the entire thing turned me off. I was so irritated mostly I don't like the third class treatment some physicians have with us because we're just fat wives. I moved and live close enough to a MTF with honestly better docs than I have seen in the civilian sector. Basically I waited, I am still in disbelief that I had a $15,000 procedure but at the same time they probably saved money on all the health problems that were to be. Oh, let me tell you about how I got this thing done from start to finish in less than a month, you can message me if you wanna know.

Tricare does pay for VSG..

Are you sure it is the VSG and not vertical banded gastroplasty? Did they actually remove part of your stomach or did they just run a staple line down it? If you did get the VSG approved through a civilian doctor, please get in touch with Tiffany so she can get all the info she can to pursue TriCare's coverage policies. She would be able to use the fact that ANY sleeve gastrectomy has been paid for in her continuing battle with TriCare and possibly force their hand by taking this information back to a Congressional Representative or Senator.

HELLO!

my husband is active duty army and tricare did allow me several referrals to civilian doctors for the vsg surgery. i lived in washington dc at the time and they were trying to phase out the program at walter reed (since they are closing it down) and they were building a new hospital on fort belvoir that would include a new bariatric center so that only left bethesda for the whole area and they were on a 8 month to a year wait list to get into the seminar and into the program. it was a pain! i went through 6 referrals to civilians and didn't find one surgeon that i liked. i started to get very discouraged. well i called bethesda and spoke with the bariatric coordinator and discovered that due to the long wait list and the amount of pcs moves that familys in the military make the wait list was much shorter. so i got into the seminar and met the surgeon at bethesda and loved him. he was so personable and kind. the dc area is very different than other areas for weight loss surgery. it took me a year to get all my appointments done and have surgery. i almost didnt get my surgery due to a pcs move. we moved in june and my surgery was in august. i convinced my doc that i would be able to stay in dc until he cleared me to go home to az and after many long talks and emails we made it work. i am now 5.5 months post op and i have lost 85 pounds since surgery and 35 pre op. i still have another 40 or so to go but i will say that this is a fight that i am glad i didnt give up on!

best of luck to you!