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Tricare and abdomnioplasty



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Like I said, I am moving forward with a well documented PS but at the price tag it would be great for tricare to cover any portion. I have documented psoriasis and I am still having to appeal.

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Well I won my appeal! It's not even going to cover half but I am glad it is covering some. It pays to stick with something!

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Yay Mary!!! I am so glad you won. Wish it was more but it helps.

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Congratulations! That's great news!!!

Susan

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I wrote a letter stating briefly my journey and explaining the continued success of my weightloss would depend on the skin removal. I believe it helped that I submitted a letter from my bariatric surgeon as well as my PCM that is was necessary and not for cosmosis.

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I haven't been officially rejected yet, I am assuming. My doctor put the authorization in on Friday. I had the ryn-y 21 months ago and have maintained my 135lb weight loss for the past 6 months. I have the sores, rashes and infections. It's all very well documented by my PCM and now a surgeon. I have heard it's near impossible to get approved right out the gate so I am trying to learn as much as I can from other Tri-Care patience who have had success. We are active Prime but would consider changing to Standard if it would help my cause.

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You have one shot to appeal the denial. The letter you write is important so take your time with it the only other thing is to pick a plastic surgeon that will fight for you? Mine was imperative in getting the appeal reversed.

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Tricare paided for my Tummy Tuck. I had my band and in 2011 I had my tummy tuck in 2013 and was covered. Im' now having a revision from band to bypass on the 30th that tricare is covering also

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I received my approval for both the panniculectomy and abdominoplasty. I was feeling very confident they would approve the panniculectomy portion but figured I would have to pay out of pocket for the rest. I am feeling very blessed for the dual approval, I know in today's TriCare would it's highly unusual. Surgery set for 21 May.

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I received my approval for both the panniculectomy and abdominoplasty. I was feeling very confident they would approve the panniculectomy portion but figured I would have to pay out of pocket for the rest. I am feeling very blessed for the dual approval, I know in today's TriCare would it's highly unusual. Surgery set for 21 May.

How did you get them to approve it? I'm having so many skin problems it's not even funny.

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I received my approval for both the panniculectomy and abdominoplasty. I was feeling very confident they would approve the panniculectomy portion but figured I would have to pay out of pocket for the rest. I am feeling very blessed for the dual approval, I know in today's TriCare would it's highly unusual. Surgery set for 21 May.

Congratulations!! As I said, Tricare is only covering the panniculectomy. My plastic surgeon didn't even submit for abdomnioplasty as it is strictly cosmetic and won't be covered which I believe because he had to talk with tricare multiple times just to get panniculectomy approval. I am content with the discount I am getting and now focusing on the procedure and recovery......you should hear from me next week!

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Anyone have AETNA insurance? Ifso how long did your approval for plastics take? on breast reduction or TT...

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Post op day 3 of abdomnioplasty and couldn't be more happy!

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    • KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
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    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
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    • BeanitoDiego

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    • ChunkCat

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      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
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