So Frustrated. Had VSG several years ago in Mexico, but struggling. My primary care dr referred me to the local Bariatric surgeon in my area, and they're the only ones covered by my insurance. After I told them I was sleeved in Mexico originally, they refused to see me. I'm sad and frustrated. I really don't want to go to Mexico again for a revision (not that it wasn't a good first experience, just I have a family and kids now, so the cash isn't there to get it like it used to be.) This is just a vent post. I'm just sad about the situation.

I just found this on TRICARE-west.com. I would ask the insurance company first to make certain this is for all TRICARE but as you can see your answers to these questions should be satisfactory for them to let you see whatever doctor is willing to help you. They just want to know that you are not just being picky with doctors and that you tried to find someone in network first. You just have to get approval ahead of time. And be certain to ask if approving this means they are covering it at an IN NETWORK RATE

In the rare case that network providers are not available or there is a clinically significant reason care must be provided by a non-network provider, clear and detailed documentation must be provided for consideration of this request. The documentation should include answers to the following questions:

• Is the request due to a beneficiary preference or is it based on medical need?
• Has the beneficiary seen other specialists who cannot manage his or her condition? If so, please provide consultation reports.
• Have all available network providers been ruled out? If so, which network providers have been contacted?
• What is unique about the patient's condition and/or the provider's credentials that requires him or her to see a non-network specialist?

Edited September 1, 20223 yr by ShoppGirl

On 09/01/2022 at 13:10, oldandtired said:

I too have Tricare. It might just be an excuse, as quite frequently some doctors won't take Tricare. Doesn't pay enough.

A thought: make them put it IN WRITING why they refuse.

This sounds like an excellent idea. Request a notice in writing with reason.

When it comes to Medical Tourism, I believe the issue with American doctors not providing care after the fact that you had a surgery in a foreign country, is a liability issue. If the surgery that took place in another country was done inappropriately, etc... the American doctors, if they choose to revise the surgery, or provide care, becomes entangled into the original surgeons "problems" with the surgery, and can face a lawsuit, etc. It's due to foreign surgeons being governed by different medical entities than in the US. It's a huge liability thing. I have a friend who went to Mexico and got her VSG and her primary care doctor told her no one will touch her stomach here if she ever has issues.

I truly hope you find a way around all of the medical bureaucracies that you're up against, and get your revision.

Best Wishes! ?

I'm kinda late in this conversation. Maybe "stop telling them ..Mexico." I'hv been fighting to get revision from sleeve gastric to gastric bypass for 3 years (found out last year tI have 2 hernias and need robotic surgery due an earlier herina issue). I started a new job and have a new PCP. She referred me to a specialist immediately.
Go to 250 miles to find a doc. You have the coverage.

Since my insurance doesn't cover bariatric surgeries, I am also planning my gastric sleeve surgery in Mexico. I sought a surgeon in Mexico who was a member of the American Society for Metabolic and Bariatric Surgery (ASMBS). I would check to see if your surgeon was accredited by the US medical board. if so, I would first point out the membership to your local doctors; if they still refuse, I would notify ASMBS that your local doctors are refusing to treat a patient of a fellow member.