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Tricare denied revision

Stay_Tuned

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Stay_Tuned    0

Stay_Tuned
Posted

My port is detached and my surgeon sent in for an approval to have the port revision done. Tricare DENIED the surgery.....:D

They state it is because the FDA has not proven that the surgery is needed to make the initial surgery work... Hmmmmm so I have the lapband placed.. BUT it cant be accessed.... how is it NOT needed....??? :confused2:

I have filed an appeal.....The process could take 60 days...I am in a bad place right now... this is TERRIBLE... band placed May 21st....can not use it.... I feel like I am in a bad dream and need to wake up.....:unsure:

Anyone else have this experience.....and can offer advice or outcome?

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JamieNP    20

JamieNP
Posted

Lap band IS FDA approved! You may want to enlighten Tricare!

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Stay_Tuned    0

Stay_Tuned
Posted

What they are saying is that the FDA has not PROVEN that there is a need for port revision when it is detached for the actual lapband surgery to work correctly.

So they approved the lapband and I had it.. but when I went in for my first fill the port was flipped AND detached.. there was no way to turn it over to put the saline in so I can actually use the lapband device... What tricare is stating is that the FDA has no factual information that the 2nd(revision tot he port surgery) is necessary to make the lapband work...

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MistyD65    1

MistyD65
Posted

That's just ridiculous.:whatchutalkingabout Just goes to prove that insurance companies are more interested in keeping their money than in paying it back to us when we legitimately need it.

Good luck with your appeal.

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KayleighsMommy    16

KayleighsMommy
Posted

Duhhhh... they paid for the original lapband, but now that it is unusable (for all intents and purposes) they won't pay for the surgery to make it work???? :whatchutalkingabout An empty band is going to do you no good at all. Hopefully they will see the error of their ways soon. My best to you.

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luluc    6

luluc
Posted

what would your surgeon charge you to self pay? i realize that may not be feasible & your ins SHOULD pay - was just curious as to how much your dr will help your situation...

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Lshelley21    0

Lshelley21
Posted

that sounds like a nightmare...i couldn't imagine going through what you are going through. WOW...perhaps i will ask if it can be stiched in place!!

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carletonhoward    0

carletonhoward
Posted

You would think that since the surgery was not done that long ago he would fix his work. I am getting banded on the 18th and my surgeon told me if something happens in the first year he wold take care of it.

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Stay_Tuned    0

Stay_Tuned
Posted

Yes nightmare is right.. I dreamed about being in court fighting all night !! I just want this whole process to be over...

I have not asked the office for a quote for the revision.. I am still holding out hope that tricare will see the error in their ways and pay for the revision....

I believe I am one of the first few who have needed the revision since tricare started paying for the lap band in January....I am hoping my hard path will make it easier for those who come after me...I believe this is ALL just red tape.....

As you can see... I am TRYING with all my strength to remain hopeful... I just havent had lots of happy times since my surgery and I am not able to use the device.... BUT I am still working out an hour a day 5 days a week and trying to maintain or lose... not gain!

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Stay_Tuned    0

Stay_Tuned
Posted

after LOTS of moaning and complaining and trying to understand WHY they denied.... we found out there is a list of DO NOT PAY codes... and mine is one of them.. there is NO WAY to appeal it...so basically myself and my doctors office did all the walk they wanted us to walk.. and there was NEVER a way to get it covered with that code...

Ok soo... we are submitting under another code....

Wish me luck

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*slim*    2

*slim*
Posted

after LOTS of moaning and complaining and trying to understand WHY they denied.... we found out there is a list of DO NOT PAY codes... and mine is one of them.. there is NO WAY to appeal it...so basically myself and my doctors office did all the walk they wanted us to walk.. and there was NEVER a way to get it covered with that code...

Ok soo... we are submitting under another code....

Wish me luck

I wish you the best of luck. It would have been nice if the insurance company had told you about the do not pay codes when you were first denied. That would have saved you a lot of time and stress. Of course, I know that they don't make anything easy. Anyway, good luck to you.

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Stay_Tuned    0

Stay_Tuned
Posted

I am now approved for my revision... FINALLY!!!

I am also going to have an upper GI as well.. due to getting reflux lately and also a incident of being stuck....Mind you I have no fill at all...

So to be safe I am going to have that done on Wednesday.... Also I am going on shakes for a few days to get rid of any swelling that may or may not be there....

So that is the story so far.....

Revision on the 17th of Sept....

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MistyD65    1

MistyD65
Posted

Hooray! :thumbup:

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thatDEgirl    1

thatDEgirl
Posted

Wonderful! Thank you for posting too...I was paniced that if I ever had a problem, Tricare would balk at covering.

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Go To Topic Listing Revision Weight Loss Surgery Forums (NEW!)

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

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