No, they don't, unless it's a medically necessary procedure. Or, I think I remember some talk a few months back about how some MTFs do those types of surgeries on Space A basis, but you'd have to inquire of your local MTF to see if that's an option.
only a very small number of facilities offer the surgery alone to keep their surgeons certified. It is on a Space A basis and the waiting list is often 2 years or longer. you start with your PCM and you also must go through a psych consult to prove that the issue is negatively impacting your life.
TRICARE doesn't cover it, the Hospital does, and then again, only to certify their doctors.
In a nutshell: YES...if it is deemed medically necessary (like theainjmtant stated).
I have never heard of liposuction, but they will cover the cost of a tummy tuck or breast augmentation. I have lost 165 lbs (I have 35 ish more to go) and I am having back problems caused by the extra skin. My PCM is putting in a referral to send me to either Anchorage or Washington state for a consult.
So yes, even if not done at an MTF, Tricare will pay for it.
I think this reply is a bit misleading - it is not yes in a nutshell/for the majority of people, because there are VERY few cases of medically necessary cosmetic surgery - especially so for a breast augmentation, I'd see them more going for a tummy tuck for reasons you mentioned. But for most people this is purely a cosmetic procedure, in which case it is NOT covered except for the MTF exception.
I think people would be surprised to learn how many gastric bypasses, the military is doing for spouses. As a result it has increased the need for tummy tucks and breast and body lifts. My neighbor lost 250 pounds after her bypass. The military did her body lift, and sincer her breasts were all skin. They did a lift and implants.
As for me my breasts are very big for my stature. I have had major back problems because of it. The military put me on the list for a reduction. When my turn came up my husband was deployed and I didnt have anyone to watch my kids. So I deferred and they estimate I will be called again in about 6 months.
Bchamberlin: breast reductions are almost always medically necessary. Tummy ticks or liposuction are not.
the process for getting approved for GP is not an easy one by any stretch of the imagination and thus the follow on procedures are often nearly as difficult to obtain.
I don't think it's an issue of not having a concrete answer, it's a matter of having to split hairs because at least in this case, the answer is that varied but also specific.
For example, using the term "breast augmentation" probably won't get you anywhere - it usually means enlarging through implants. That would be a medically necessary procedure in I would guess no more than 1-2% of women, if not less. Breast reduction, on the other hand, can indeed be medically necessary for a lot of women. A tummy tuck can be necessary for a post-gastric bypass person, but liposuction, I think not.
And bchamberlain, the other thing other than that MRSJVB mentioned is that a gastric bypass is NOT a cosmetic procedure - so yes the military would understandably do them. But that does not necessarily mean that they will turn around and do the tummy tuck - or less so a breast or body "lift". It would be a definite issue of case by case basis.
To the OP, and anybody else who cares - I do believe that the procedure will always involve getting a referral from your doctor, because it takes a doctor to claim something is medically necessary, so as was suggested a few times now, call your provider or your MTF to see what they're willing to do for you - you'll never know until you try.
FYI, at Balboa in San Diego, they do cosmetic procedures (on a limited basis) in dermatology, but you pay for them. I don't know exactly how it works or how much it costs, but I saw a sign when I was there having something else done. I asked the docs about it because I was curious, but it sounded like chemical peel or something really harsh and the docs said they didn't think it made enough difference to go through that much pain!
The interesting issue I notice here is the deadline. You'll see that it says, for example, it states "To be covered, surgeries must be performed no later than December 31st of the year following the accidental injury or surgical trauma, except in the case of postmastectomy reconstructive breast surgery or cases involving children who may require a growth period."
Does that literally mean that if you have a weight loss surgery such as Gastric Bypass, or the newly approved Lap-Band, you only have until December 31st of that SAME year in order to have this "follow up" surgery performed and covered? For example, if you have weight loss surgery on December 29th, you only have 2 days in which to have this surgery in order for it to be covered? That doesn't seem to make sense since it takes months following such surgery for someone to lose a significant amount of weight to make this surgery "worth it". I've also been reading on these boards that even if you don't have weight loss surgery a "tummy tuck" can still be approved. Not sure of all the details on that either.
of the year following the accidental injury or surgical trauma
With it stating "of the year following the accidental injury or surgical trauma", I understood that to mean the upcoming December 31st, not the 2nd December 31st following the surgery. Certain things like this are often misinterpreted so I'm assuming I'm another one of those who got confused. Sorry for any inconvenience or for sounding stupid.
I think Blondie needs to weigh in on this. If I'm not mistaken she's had a skin lift following bypass. There is a certain criteria that MUST be met for a referral for tucks and lifts. I do not know what the specifics are on that criteria though.
And believe it or not, they will do an augmentation for female soldiers to enlarge their breasts.---IF they meet the criteria.
My old neighbors friend was able to get tricare to cover bigger breasts, she paid 3500 out of pocket for it. She bragged about it all the time, how she simply told her doctor she wanted bigger boobs if it was winter she wouldnt care but since it was almost summer she really needed bigger boobs for her bikini, and he wrote a referral and she got her boobs...
I havent personally known anyone who got a tummy tuck or anything like that just breast enlargements and reductions.
I've recently discovered this in the current Tricare Policy Manual:
"Panniculectomies primarily performed for body sculpture procedures/reasons of cosmesis (unless it is medically necessary and an integral part of the restoration of the patient’s function)."
I'm not sure what all is required or how your referral for such needs to be worded. This sounds like an option for those who are overweight due to say a medical condition, or not due to an eating or other mental disorder. For people in that situation, I don't understand how a gastric surgery is really the answer when diet or their own will power isn't the problem.
It'd be interesting to know how such surgery can be covered as a first option compared to gastric surgery for patients like that. Can anyone shed some light on what is required or considered for requesting such a surgery without (or as a previous option before) a gastric surgery? I guess that's the real answer we're all wondering about.
generally speaking, you start with your PCM and say: I wanna lose weight. you must be at minimum 100 lbs over weight or have co morbidity factors such as hypertension or diabetes. then you must actively try under doctor's supervision for 12 months to lose the weight on your own. this can be a Nutritionist or your PCM or another specialist, but the 12 months is standard before ANY surgical alternatives will be considered. There will also be a Psych consult as well to determine if there are any underlying non medical reasons for the weight gain/lack of loss as well as to determine the psychological impact the weight has. you can't just tell the doc: 'my self esteem sucks, gimmee surgery to lose weight' This may also include an exercise program as well to get rid of flab.
then assuming you jump through all those hoops and you are considered a candidate, you go on the very very very long waiting list. from start to finish this can easily be a 3 or four year endeavor depending on which hospital you are going through to have the surgery done at and the availability of a slot/surgeon/OR.
In most cases tummy ticks or other such surgeries are only performed when so much weight is lost that there are literally excess pounds of skin causing major irritation and chafing
Thanks Mrsjvb for that clarification. In my case, I've been trying to lose weight for nearly 20 years now. My medical condition that is causing my weight problem wasn't discovered until 10 years ago. By then it had progressed so far that it can't be properly managed.
Since then, under doctor's supervision as well as 3 nutritionists, I have tried everything imaginable to lose weight. Funny thing is, the harder I try to lose, the more weight I gain. My weight fluctuates drastically on a continual basis. I'm not sure if this is the cause, but I already have this problem of drastically hanging skin that has been causing rashes, blisters and infections for years. It also affects mobility.
For someone in my position where weight is caused solely (or primarily) by a medical condition, learning about this option is another alternative to gastric surgery, which doesn't properly address the issue. In my case, my body is in a cycle due to my weight. My specialist has told me that if I could just lose some amount of fat that has build up, the cycle will be broken promoting more of a chance that I will lose weight without having to resort to gastric surgery. For me it's a complicated and rare medical condition. Breaking the cycle is key and if this type of "cosmetic" surgery can help achieve that, it will save the MTF money and promote better health for me. I hope this helps others in a similar position since it opens other options that may not have been realized. Thanks again for the process clarification.
Yes, they do pay for tummy tucks (any procedure needed because of severe skin rashes or skin infections). I had a TT 6/2008(prepare for the pain!). I had a gastric bypass 10/06 and lost over 120lbs. The key to Tricare paying is document, document, document. You will need pictures of all rashes caused by skin on skin contact. You will need to visit your PCM with every rash and skin infection for him/her to document in your file. I was approved within 3 weeks after my surgeon’s request. Good luck.
I have spoken to my (what I consider to be) PCM about this recently since the MTF has caused a delay and ultimately cancelled my referral for gastric surgery without reason. According to my doctor, it has been very hard for his patients to be approved for plastic or reconstructive surgery. He told me in one particular case a patient of his had a gastric bypass. For years after she had lost the majority of her excess weight she was being repeatedly seen to treat the rashes and skin infections like I have. The MTF kept denying her requests for plastic surgery to remove the excess skin. Even though every incident was clearly documented each and every time within her record, which was reviewed at the time the referral was received, they still kept denying her. The doctor even sent a written request pleading for the surgery to be approved and again documenting every case of infection. This went on for over a year when finally the woman had enough and planted herself right outside of the Commander's office at the main MTF which kept denying her referrals. She sat there all day waiting for him to finally acknowledge her. She was finally seen after waiting several hours and went off on him for his facility's repeated denials. He finally agreed to approve her surgery, but only to silence her. This is the same MTF that has caused all of my problems with violating policy and cancelling a referral instead of deferring it to the network when they can't see you in the 28 days called "access standards". So apparently it all depends on which area you are in when requesting such a referral and how much of a fight you're willing to put up to get the process approved. My doctor even offered to put in a referral for plastic surgery now, since it looks like I'm never going to be able to see a gastric surgeon about my possible options with that surgery. Since my weight is caused strictly by a medical condition and we've been trying everything proposed, my doctor says he can put in a referral just for the plastic surgery now and then fight for it to be approved. Since the hospital has cancelled my 2nd request for a gastric surgery referral I'm left without options at this point and apparently this is my only option left. It's always a ridiculous struggle when it comes to my local MTF hospital approving a procedure that Tricare clearly covers (even with certain conditions being met). So I know it's going to be a battle. I've since started an investigation with Congress about this matter since the hospital simply refuses to abide by the medical policies set forth by Tricare and the DoD. If this doesn't produce any results, the Sentaor's office will go forward with submitting a formal complaint to the Department of the Navy and demand a proper response. This is taking a lot of effort, and time nonetheless, but I'm hoping this will prevent others in the same position to have to go through all of this crap for themselves. I'm hoping I may be saving them from enduring all of this as I know how ridiculous and troubling it's all been. It has created a terrible amount of stress which is also affecting me physically at this point. Even though Tricare will cover a procedure, that doesn't mean the MTF/hospital is going to approve it. Your doctor is the first step in documenting that the procedure is medically necessary (following Tricare guidelines), but then the MTF/hospital still has a right to refuse the procedure even though Tricare will cover it. I just wish this was a simple process where only one authority has a say over what is approved. After all, if Tricare will cover it and you've met all criteria, why does the MTF/hospital have a right to refuse the procedure in it's entirety (and not even let you see a network specialist)? Sure we can use Tricare Standard or Extra, but why should we considering Tricare is WILLING to pay for a procedure that you've already met criteria to be eligible for in the first place? I swear I just don't understand why Tricare and the MTFs have to be on different sides. There should just be ONE administration that has jurisdiction over all of Tricare health options, including with the MTF. Having it split up with no real management to submit a complaint to regarding the MTF is really ridiculous. I'm glad that some people don't have any problems when it comes to referrals and specialty care. But it really depends on the area you're assigned to.
