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Thread: Duodenal Switch and Tricare

  1. Sunshiney with the heart of a Ragamuffin
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    #1

    Duodenal Switch and Tricare

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    Anybody have experience with getting bariatric surgery approved, specifically Duodenal Switch?

    I'm 100+lbs overweight, no co-morbidities other than weight-caused joint pain. I do, however, have a very strong family history of diabetes, hypertension and hyperlipidemia. Those are the reasons I want the DS rather than any other kind of bariatric surgery.

    Thanks,
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    #2
    I don't know of anyone who had the DS specifically, but I know a few of us who had RnY Gastric Bypass and a few others who had gastric banding approved.

    For me specifically, I was more than 100 pounds overweight and I had had my gallbladder removed previously, and I had pretty bad reflux as a result of the gallbladder surgery, so my surgeon added Cholecystitis and GERD as my co-morbidities, which made me eligible. Have you had a consult with a surgeon yet?
  3. Sunshiney with the heart of a Ragamuffin
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    Yes, I consulted with Dr Stewart in Denton and he's approved me. I've had an EGD and all the bloodwork. His office will work on insurance--right now we are self-pay (22k )

    I had an HIDA scan a few years ago and it came back OK but DH is still convinced my gallbladder is rotten, I get an excruciating pain in the general area of my gb. My family are all obese and tend toward back problems, including a narrowing of the spinal column made worse by weight. We also get DMII, HTN and hyperlipidemia. As I said, my family history is what makes me want the DS. I'm basically a ticking-time bomb and I'd like to be defused before I get there.

    The DS is the only surgery with a 95+% cure rate for diabetes, htn and hyperlipidemia. It is also the only one with a regain rate of less than 20%.

    So my plan is, that once we find out DH is 'in' and we have Tricare, I'm going to call Dr Stewart's office and see what can be done. I just am curious if anyone else has gotten it done.
  4. Waiting Around
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    #4
    you won't be able to just call the dr. you ahve to make sure he accepts tricare. But first you have to go through your PMC and get approved and so on. Unless you switch to tricare standard. But then you have co pays.
    Tricare prime is free.
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    Oooh yeah unfortunately since you're not already on Tricare, you may have to go through the motions of all this again even though you've already been approved, in order for them to cover it. If you're particularly attached to the surgeon you've already spoken with, you may want to use Tricare Standard for a while, which will allow you to choose your own physicians, assuming they accept Tricare. On Tricare Prime (the one without copays) you will have to have the surgery with a military surgeon or, if one is not available, they will refer you off the military facility. That's what happened for me- there was no medical on post for dependents where I had my surgery, so I had a civilian doctor who referred me to a specific surgeon. Anyway, best of luck! I hope it can all work out the way you are hoping.
  6. Sunshiney with the heart of a Ragamuffin
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    #6
    Thank you, I appreciate the input.
  7. TTC :D
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    #7
    I just had gastric bypass surgery myself two years ago...I had tricare at the time so they paid for it. But I am afraid I'm going to have to burst your bubble on this one. Tricare does not currently cover the DS. As a matter of fact it because the DS is still new it is considered somewhat experimental in the eyes of insurance companies. Which means the vast majority of insurance companies WILL NOT even consider it. My best friend had the DS done... she went to brazil and paid 10 grand for it... besides losing the weight she has had nothing but issues with her proceedure.. including several hernias and such.
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    #8
    I'm currently going through the approval process for DS. More and more insurance companies are covering the DS and those that don't can be appealed and more and more are agreeing to it. Tricare used to cover all bariatric surgeries until 2003 when each surgery received their own insurance code and then they stopped covering the DS and the sleeve.

    With that being said, Tricare WILL pay for the DS but only if the surgery is by a military doctor. Currently the only MTF that is performing the DS is Madigan Medical Center at Ft. Lewis in WA. Dr. Matthew Martin first introduced the DS there 12-18 months ago and several of the other surgeons are now performing it.

    You will need to get a referral from your PCP to Madigan's bariatric program. Your referral will go before the obesity review board and then approved or denied. If it is approved you will be entered into their "Pathway" program which will include your pre-op testing and education. If you do not live in WA you will perform a version of the Pathway through your PCP and once it's complete the info will be sent to Madigan and they will contact you with a surgery date. Out-of-town patients usually stay in the hospital for 5 days and are required to stay in the area around 2 weeks after the surgery for follow-up appointments before they are released.

    It is a little complicated, but IMO it's VERY worth it to get the surgery that you want that fits your lifestyle the best. I'll be travelling from TN to WA for the surgery...I just won't settle for anything less than the DS. There are currently only around 150 surgeons in the US that perform the DS so most patients have to travel a bit to get it anyway.

    If you haven't already, check out the obesityhelp message boards. There is a forum dedicated just to the DS and is extremely helpful.

    Good luck!
    Last edited by irishtwinmom; 07-04-2010 at 03:28 PM.
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    #9
    Thank you for that info irishtwin! You were so wonderful to share that with everyone.
  10. TTC :D
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    #10
    ohhh real quick! I didnt have any comorbidities either hun... and they turned me down the first time... turns out without comorbidiies you have to be 200% of your ideal weight... or atleast thats what i was told and had to go through 2 years ago.... this may have changed.. but just a heads up incase it hasnt!
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