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Thread: Tricare Coverage Question

  1. Regular Member
    brndnsgrl's Avatar
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    #1

    Tricare Coverage Question

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    It's been a long time since I posted, but I have a question & I knew you all would know the answer!

    My OB recommended that I have a tummy tuck, mainly to fix the issues that I have with my abdominal muscles being separated. I saw my primary care doctor on base this morning and she agreed, she said I need surgery to repair those muscles. I am requesting that I have this done with a plastic surgeon. The one I want doesn't appear to be in the list of Tricare Humana approved physicians, but he does accept Tricare. The referral office told me that doesn't matter, if he's not on the list I can't see him. So I'm ok with seeing someone else as long as they're good & I trust them.

    This is my question- since my primary care doctor recommends I have surgery and has put in a referral for me, does this mean that Tricare is going to cover this surgery? Or after I see the surgeon & he recommends it as well, can Tricare still deny it? I've seen a lot of people say that Tricare deems a diastasis rectus repair surgery as "cosmetic." I've never really had any medical issues or used Tricare for more than primary care appointments, so I'm not real familiar with the process.

    Thank you!
  2. I'm a boss playa', I don't bleed like you.
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    #2
    I think if truncate puts a referral in for you then they are going to cover it. Are you prime or standard?


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    #3
    I know several people who have done or looked into breast reduction. I imagine it is the same process. (You might send a PM to BiggyBiggs.) I believe it is not automatic. The doctor recommends it but the Tricare still has to approve.
    Science always wins over bullshit. ~Dick Rutkowski
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    #4
    If they can repair the muscles without doing a tummy tuck, it is very likely that is what they will approve rather than a full tummy tuck.
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    #5
    Tricare will approve it ---- if the doctor codes it as a repair not as a tuck.

    I have a friend who just had this approved- her doctor performed the complete tuck, but only billed it as a repair and ate the difference in cost. my friend was Tricare prime.
  6. Regular Member
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    #6
    I'm Prime. I spoke to a surgeon's office (who is a former Air Force doctor actually) and he will accept Tricare and bill it so it will be covered. Only, he's not on Tricare Humana's "preferred physicians" list. A military spouse friend told me today though that I can ask them to let me see him anyway since he'll accept Tricare, and I have to sign something saying I won't ask for them to pay my mileage or something?

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