Tricare denied revision

Stay_Tuned · 08-12-2008, 04:31 PM

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

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 LAP-BAND® 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.....

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

JWRN · 08-12-2008, 04:48 PM

LAP-BAND® IS FDA approved! You may want to enlighten Tricare!

Stay_Tuned · 08-12-2008, 04:52 PM

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 LAP-BAND® surgery to work correctly.

So they approved the LAP-BAND® 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 LAP-BAND® 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 LAP-BAND® work...

MistyD65 · 08-12-2008, 05:22 PM

That's just ridiculous.

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.

KayleighsMommy · 08-12-2008, 05:23 PM

Duhhhh... they paid for the original LAP-BAND®, but now that it is unusable (for all intents and purposes) they won't pay for the surgery to make it work????

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.

luluc · 08-12-2008, 05:55 PM

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...

Lshelley21 · 08-12-2008, 05:56 PM

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!!

carletonhoward · 08-12-2008, 06:56 PM

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.

Stay_Tuned · 08-13-2008, 08:08 AM

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!

Stay_Tuned · 09-05-2008, 02:30 PM

after being in the appeal process Tricare held up the denial of my surgery to repair the port!!!

Stay_Tuned · 09-05-2008, 05:23 PM

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

*slim* · 09-06-2008, 08:32 AM

Quote:

Originally Posted by Stay_Tuned

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.

Stay_Tuned · 09-08-2008, 04:54 PM

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....

MistyD65 · 09-08-2008, 05:47 PM

Hooray!

thatDEgirl · 09-08-2008, 10:40 PM

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