TriCare Select and VA Disability

txgray

I have just been diagnosed with ILC Er+ Pr+ stage 2 in both breast. Unfortunately I dropped my work insurance during open season before I was diagnosed. Now have only Tricare select and the VA for Insurance. I met with my Surgeon and the Plastic surgeon and am planning on doing a DMX with Nipple sparing mastectomy with immediate reconstruction on both breast if possible, Depending on what the surgeon discovers I may end up with a 2 stage reconstruction. I have called Tricare 3 times and keep getting different answers on what they will cover. If they will not cover it should I enlist the help of the VA. I am so frustrated and stressed out trying to deal with the financial implications of my care. Has anyone had any success dealing with Tricare select an or the VA?

Moderators

Hi txgray, and welcome to Breastcancer.org.

First, we're so very sorry to hear of your diagnosis, but we're really glad you've found us. You're sure to find our Community an incredible source of advice, information, encouragement, and support -- we're all here for you!

While you wait for the ever-helpful responses from our other members here, you may be interested in checking out the main Breastcancer.org site's section on Paying for Your Care, specifically the Managing Your Health Insurance page, which offers some helpful tips on dealing with your insurance company.

We hope this helps get you started here. Please come back often and ask lots of questions. We'll be right here with you the whole way!

--The Mods

navy1305

Hello txgray,

I am sorry to hear about your diagnosis.

I can probably answer any questions you have about the VA since I get my healthcare through the VA. Please note that VA healthcare is NOT insurance. I also have Blue Cross from work and TRICARE since I am retired. Please let me know the specific questions you have.

Also, this is VERY IMPORTANT: If you have TRICARE Select and did not already know this, be sure you pay the premiums that went into effect this year, otherwise you will lose coverage really soon. You do not need to pay TRICARE Select premiums if you/your sponsor was medically retired, if you are a survivor of an active duty sponsor or medically retired retiree, or if you are an active duty family member. The details are here: https://tricare.mil/Plans/Enroll/Select/Enrollment...

SpecialK

txgray - I have Tricare Prime and had a skin and nipple sparing bi-lateral mastectomy with tissue expanders, then silicone sub-pectoral implants. My surgeons were Tricare authorized providers that I needed a referral for and I paid minimal co-pays for the surgery, but no deductible, and no balance bill afterward. My understanding is that with Tricare Select you can choose any Tricare authorized medical professionals without needing a referral, and your out of pocket is limited to co-pays/cost share/deductible up to your catastrophic cap, like most insurance plans. I would make really sure about getting an auth beforehand though to make sure that the kind of surgery you want is covered, and that can be accomplished by seeing a breast surgeon and plastic surgeon that are in network for you - paying the co-pay or cost share for that appointment, and having them submit the planned surgery for the authorization. There has been some confusion about skin and nipple sparing among people who have that surgery as it is described in some insurance wording as an incomplete type of mastectomy, but hopefully that has been cleared up. I live in Tampa which has a VA Hospital with a dedicated breast center. The VA here in Tampa is right across the street from both a university based healthcare system, and Moffitt Cancer Center, an NCI facility. Is there a VA Hospital with a Breast Center near you? The surgeons that see VA patients there for breast health concerns are the same ones that see civilian patients in the community as well, with Tricare and other types of insurance. They have limited surgical days at the VA, but are local non-military surgeons that I would certainly personally use. They operate on patients at the VA, and your post-op care can either be there or at the doc's regular private office.