Following significant weight loss, many individuals are left with excess skin. This article will explore Tricare's coverage policies for skin removal surgery, often referred to as plastic or reconstructive surgery, after bariatric surgery or other weight loss methods.
Tricare and Weight Loss Surgery
Tricare, the healthcare program for uniformed service members, retirees, and their families, does cover weight loss surgery (bariatric surgery) under specific conditions. To qualify, beneficiaries must demonstrate that they have attempted and failed other weight-loss programs, such as medically supervised diets or programs like Jenny Craig or Weight Watchers. It's important to note that Tricare does not cover doctor's office visits specifically for obesity treatment, non-surgical weight loss procedures, gym memberships, or weight loss programs themselves.
According to Health Affairs Policy 07-006, bariatric surgery is considered a major and permanent change to the digestive system, necessitating strict adherence to a specific dietary regimen that may impact operational deployment.
Skin Removal Surgery After Weight Loss: Is it Covered?
After successful weight loss, excess skin can become a significant issue. Tricare may cover surgery to remove this excess skin if it's deemed medically necessary. This determination hinges on whether the excess skin causes health problems.
Medical Necessity: If large folds of skin become infected, irritated, or otherwise cause health issues that require medical treatment, Tricare typically covers plastic surgery to remove the excess skin. The presence of these complications is crucial for coverage approval.
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Cosmetic Surgery Exclusion: Cosmetic surgery, defined as elective procedures aimed at enhancing appearance without addressing a medical condition, is generally not a covered Tricare benefit. Patients seeking cosmetic surgery have the option to be seen in the private sector for care without a deferred referral. Active-Duty patients must have their commands approval prior to any elective/cosmetic surgery and such patients should be advised to get command approval prior to seeking care in private sector for all cosmetic surgery. All cosmetic surgeries and related complications are paid by the individual patient not Tri-Care. Cosmetic surgery referrals are accepted on a space available basis or will be denied.
Navigating the Process
To determine if skin removal surgery will be covered, it's essential to consult with a physician who can assess the medical necessity of the procedure. Documentation of skin-related health problems, such as infections or irritation, is crucial for the pre-authorization process.
Tricare's weight loss surgery policy provides further details on coverage criteria and requirements.
Plastic and Reconstructive Surgery Services
Military treatment facilities often have Plastic and Reconstructive Surgery departments that provide evaluation and treatment for a range of conditions. These departments prioritize active duty service members, their dependents, and retirees, in that order. The focus is on restoring form and function.
Accessing Care
A referral or consult can take up to 72 hours to be approved. Once your referral or consult has been approved, you may make your appointment by calling our clinic directly at 757-953-2883. Follow-up appointments are scheduled by our clinic staff. Patients should check in at our clinic's front desk 15 minutes prior to their appointment.
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Due to the nature of our patients, we have 4 priority levels, and our wait list is very large. Unfortunately, this makes it very difficult to accurately predict waiting times. Please feel free to contact us for status updates if it has been longer than a 6 month wait.
Wound Care
The Wound Care Center ensures readiness by providing comprehensive, quality healthcare services to our armed forces and their families by offering our entire spectrum of consultative and therapeutic services within our nursing specialty. A referral or consult can take up to 72hrs to be approved. Once yours has been approved, you may make your appointment by calling our clinic directly at 757-953-2849. Follow-up appointments are scheduled by our clinic staff. Patients should check in at our clinic's front desk 15 minutes prior to their appointment.
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