Weight Loss Surgery - Wanted to let all the Military Triwest Insurance people know....




tfarah
06-25-2005, 12:54 AM
Hi! I just found this out today. I called Triwest (military) insurance company today and found out that at Balboa Hospital(san diego) that if you have the weight loss surgery there then Balboa has plastic surgeons on staff that will do all your reconstructive surgery for free. And if you didn't already know this-Balboa will also do the weight loss surgery for free and you DO NOT need to wait for insurance approval, the only person who you need approval from is the doctor. They also do all the prep work for the operation free and the Phych evaluation for free. Also, they just started doing the laproscopic surgery instead of the open bypass. And I talked in length to them, and I mean they do ALL the plastic surgery. So, that was one big thing that holds some people back-so call you military hospitals and find out!! Good luck and God bless!!


original_serendipity
06-26-2005, 01:56 AM
Ok, Balboa Naval Hospital does do gastric bypass for free ONLY if you are the dependant of an active duty person. Also, you DO need approval from TriCare West, which the almost never turned down if it is recommended by your doctor. The only way they will do the psych eval is if you are currently a patient with the mental health clinic. Otherwise, you have to be referred to an outside psychologist/psychiatrist and TriCare does not cover this. As for the plastic surgery clinic, it is only completely free if, again, you are a dependant of an active duty person. And even then, they turn down people quite frequently because they are severely under-staffed right now. About 70% of the normal amount cosmetic surgery staff at Balboa is currently deployed to the Middle East or hospitals receiving those patients who have been disfigured by artillery, gun fire, and accidents. Where did you get your information, Tfarah? I'm trying to rain on anyone's parade, but I'm in a serious "been there, done that" phase, lol. I got the call from TriCare approving me for insurance purposes about 28 hours after my initial consultation with my surgeon.

Angie

original_serendipity
06-27-2005, 03:28 AM
Ooops!! I meant I'm not trying to rain on anyone's parade. Sorry for the typo, lol.

Angie


tfarah
07-01-2005, 08:27 PM
I just had a different experience I guess. I saw an outside Phsych and it was totally covered(he was a civilian doc). I talked to the plastic surgery doctor-that's where I got my info about that. I just assumed everyone knew I was talking about Triwest prime-my mistake. A whole different set of rules apply to non-prime-in every aspect of almost everything. Are you Tricare or Triwest? Theres a huge difference between the two companies. I don't need approval from Triwest to have my surgery(that's what the general sergeon told me) He never even put in for an approval, I was told as long as it was at Balboa by a military doc and not civilian then Triwest had no say in what the hospital did or did not do. I've watched your posts for a while though so if you got more info for me I definatly want to hear it. Thanks!!!

original_serendipity
07-02-2005, 02:49 AM
TriCare and TriWest are both Humana subsidiaries. Depending on the case load of patients needing psych evals, Balboa general surgery has started asking it's mental health department to do one-time psych evals if they can spare the time. Retirees on Prime are have to pay co-pays, or a fraction of certain costs for the surgery, even though it is done at Balboa. Since my husband is still on active duty, I didn't have to pay anything. I was on active duty for 11 years, honorable discharge for medical reasons. So, all the things I had wrong with me at the time of my VA claim filing, I won't have to pay for care for those reasons. However, when hubby retires in March, we will have a yearly deductible we will have to pay, plus the standard fees for staying enrolled in Prime. But, prescriptions, for now at least, are free. If it's not available at a navy pharmacy, I only have to pay $9.00 per prescription, no matter what the total cost of the medication is, which is really nice. I have to do that with one of my allergy medicines. Normally it is $45 or more for this drug. The plastic surgery clinic will usually pay for everything as long as the referring physician states it is a necassary surgery for health reasons, like back pain, recurring rashes, and infections of the excess skin areas. If it is a retiree or his/her dependant, usually you only have to pay for anesthesia. If they disengage you to a civilian provider, you pay a small (compared to total cost) fee, such as for the anesthesiologist and the so-called meals while in the hospital (yuck!). I did about 16 to 18 months of intense research before I made a final decision on (1) that I really wanted to go through with it and (2) what type I wanted to have done.

original_serendipity
07-02-2005, 02:50 AM
Also, all my paperwork I get from the insurance people say TriWest, but the central customer service office in Balboa calls it TriCare. Maybe they are going through a change.

fl_mom
07-08-2005, 11:03 AM
Do either of you know about plastic surgery to remove excess skin from regular weight loss? Is anything like this covered by Tricare? ( i do have prime)

Thanks

caligleasons
08-29-2005, 04:55 PM
Hi everybody I was just reading this and decided to post. I had my open gastric bypass on june 20th at balboa....Everything was covered for me. I only waited about 1 month if that to have mine. I also had sever problems....I think my surgeon was awsome even tought I was the 1 out of 4 who gets complications. I hope they do tummy tucks I will need one. After 4 kids and gaining to much weight I don't think it is going to shrink.

Sherri
6/20/05 246
8/29/05 191