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TriCare Apollo Overstitch Approval

Discussion in 'Revisions' started by Vboley, Aug 17, 2017.

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    Vboley

    Vboley New Member

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    Has anyone had any success getting TriSouth to approve the Overstitch?

    If so could you please help me with the coding that should be used to get the approval to go through.

    I had the RY in 2009 and have been very successful with it until about 2 years ago (I had my son). I was told the I need revision due to having an anastomosis that is opened 5 times the normal size.

    Can anyone help.....
     
    MsVee likes this.
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    DianaCox

    DianaCox Bad Cop

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    I'm sorry to say that as far as I know, NONE of the RNY "pouch repair" procedures are covered by ANY insurance, much less TriCare, and for good reason. See, e.g., https://www.ncbi.nlm.nih.gov/m/pubmed/24634099/?i=8&from=Gastric bypass pouch repair

    "However, there was no statistically significant weight loss at 24 months postoperatively [t (4)ā€‰=ā€‰-0.16, pā€‰>ā€‰0.05]."

    You would be best served by looking into revising your failed RNY to a DS. Please do your research - and this site is an excellent place to do so.

    Your current surgeon is almost certainly NOT the one to ask about this - you need to get a consult with one of the few surgeons in the US qualified to perform it.

    Bottom line - TriCare almost certainly isn't going to cover the overstitch procedure anyway. Might as well skip to getting a permanent fix by revision to a DS. And finding some way to self-pay, unless you can get yourself to Madigan Army Medical Center in Washington State, where there are qualified military bariatric surgeons.
     
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    Larra

    Larra Well-Known Member

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    What @DianaCox said. She and I see a lot of insurance policies, and we have yet to see one that covers any of the endoscopic stitching or stapling procedures. They are considered experimental, and not accepted as standard of care. And with good reason, because, as Diana said above, the results are poor. I have yet to see anyone on any website report any significant weight loss. A bit, yes, because the procedure is followed by some weeks of a liquid diet. After that, no. And appealing a denial for an experimental procedure will go nowhere.
    Last I heard, they ran about 10K. IMHO it's a waste of your hard earned money. Given that Tricare coverage for a real revision of your gastric bypass to a DS is unlikely, you would be better served by saving up your money to, hopefully, safe-pay someday for a real revision that will actually work for you.
     
    Settledownnow likes this.

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