Tricare Insurance Surgery

[thelatinpython]

I have been looking through the discussion forums for some time now (years) and i noticed a decent amount of people have Tricre insurance. Im in the Army Nation Guard im 23 years old and have had gynecomastia in both breast since i was 13 years old. While i was in Afghanistan I went online and looked for a plastic surgeon that had gynecomastia experience. I contacted the Surgeon coordinator and explained to her about the glands in my chest etc. I then asked if they accepted tricare she said yes but assured me that my procedure was not going to be covered because i didn't have a certain amount of breast tissue. The amount of breast tissue i was suppose to have was basically a woman's A cup. So, i went to the tricare website and looked at the requirement for gynecomastia surgery coverage which is if u have any pain have had it longer then a year or breast tissue exist. I copied and pasted and sent it to the surgeon coordinator and she still assured me that it was not going to be covered.  Once I got back to the states i went to an appointment with the plastic surgeon and he told me i would need lipo and gland removal. He also told me it was not going to get approved. i told him i get a lot of pain when i wear my vest and i also told him to write it in the insurance packet he sends out to tricare. 2 weeks go by and the surgeon coordinator calls me and asked me if i have been seen by a endocrinologist i said no and again she assures me it will not be accepted, 2 weeks after that i get a call back and my surgery got approved i go in for surgery on the 26th.

Im very exited hopefully i have a speedy recovery. Feel free to ask any questions ill answer them to the best of my abilities.

[Paa_Paw]

The important thing, which you illustrated so well, Is that you do not simply accept the first denial. Sometimes you need to make waves and persistance does sometimes pay off.

[thelatinpython]

Ill make sure to post before and after pictures.

[hammer]

I'm a vet and do my medical care at the VA hospital and medical center and the VA does not do this surgery or any cosmetic surgery. I did know that you could get while on active duty if you pushed hard.

[thelatinpython]

If your actively serving and have Tricare you insurance will cover it if you complain about having pain in your breast.   

[hammer]

That is what the others have said, that their vest was irritating the breast or causing pain, something like that. They posted on here under tricare paying for surgery.

That brings me to this question. I just wonder if a female could get a breast reduction surgery while serving for the same reason?

[Dr. Elliot Jacobs]

Female breast reduction surgery has been covered by insurance far more frequently than gynecomastia surgery.  The criteria for female breast reduction was pain in the breasts, back and shoulders (due to the weight),recurrent rashes and infections in the fold under the breast, and sometimes curvature of the spine due to the weight of the breasts. 

Now, times are changing and even if a woman satisfies those criteria, oftentimes she will be denied coverage.  Welcome to the wonderful world of managed care (we in the medical field call if "mangled" care).  The US was sold a bill of goods years ago when the managed care companies promised better and more coordinated care at lower prices.  Sounded great and the US bought into it.  The problem was that these are "for profit" companies and they obviously make more money for their stock owners and CEO's if they collect a lot for their premiums but deny coverage for any elective surgery.  They are very creative in denying coverage for treatments that were indeed covered not too many years ago.

Frustrating.

Dr Jacobs

[hammer]

Dr. Jacobs, I get those rashes under my big breast too! They will actually look like rips along the fold and go from there to a full blown rash! I can usually take care of them before they get to far along by using a anti fungal cream or triple antibiotic cream if it is a open sore. I find if I wear support this doesn't happen as often. The curse of having double Ds, why anyone would get them made bigger is beyond me!


Bob

[Dr. Elliot Jacobs]

The reason these rashes are very common:  skin on skin, with warmth plus moisture (from a bit of sweat) is a perfect breeding ground for bacteria, fungus, etc.

Dr Jacobs

[hammer]

That makes since doc, that would also explain way the support helps! It keeps it from being skin on skin, allowing some air space, or a barrier between them.

Bob