Tricare coverage for DIEP?

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Mariposa109
Mariposa109 Member Posts: 61
edited June 2014 in Employment, Insurance, and Other Financial Issues

Hi,

I am trying to have a bilateral mastectomy with DIEP reconstruction. The surgeons I want to use are NOLA or Dr.Marga in Charlotte, but I am currently in North Carolina (Ft.Bragg). The NOLA people said they have to find out with tricare what they would cover. I have been waiting for a week already and have not heard anything back. I was wondering if there is anyone with Tricare Prime who has had a DIEP, whether it was a surgery tricare approved and if so, how much coverage did they give? Thank you!

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  • jacee
    jacee Member Posts: 1,384
    edited September 2010

    Call Dr Marga in Charleston. Talk to Ashley or Jenny. The number is on her website. Also, I think AnneW will probably show up and she has some knowledge about tricare. If not, search and send her a pm.

    Joni

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  • Mariposa109
    Mariposa109 Member Posts: 61
    edited September 2010

    Thank you Joni, I tried calling Dr Marga's office and Jenny told me she isn't in network. I will try contacting AnneW.

    Mari

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  • heatherbless
    heatherbless Member Posts: 295
    edited September 2010
    yes, that is weird--because I thought Dr. Massey took Tricare:  why dont you call Jenny back and ask if its Tricare standard or Prime?  I have Tricare standard as secondary, but did not use it in Charleston with Dr. Craigie.  I know with Tricare standard you would still have a 20percent--hope that helps.  Also, Dr. Craigie does not take Tricare.  Best, heather
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  • Mariposa109
    Mariposa109 Member Posts: 61
    edited September 2010

    Wow...ok..so I called back and asked to speak to Ashley this time.. and she said that Dr. Massey DOES take tricare, but she is an out of network provider.. also the problem they are having is that the surgeons she works with pulled out of tricare, so she has no one to do surgeries with... so that really sucks.. Also, there is currently only one hospital there that takes Tricare.. I guess Tricare standard is another option but I would have to see what the total for a BMX and DIEP is to see what the 20% is..

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  • AnneW
    AnneW Member Posts: 4,050
    edited September 2010

    I thought someone (SueinFL??) had Tricare and used the NOLA docs at Fairway hospital. Am I dreaming this? I'll search it when I get a chance.

    You'll definitely need two docs who work with TriCare. None will be in network, but our out of network price only changes by 5%.

    TriCare PRIME? No way. It's an HMO-type thing. No one will take it. But you can opt out of it and go Standard, if you're not active duty. Talk to your benefits folks.

    With Standard, you have a $150 deductable. Then you pay 25% of the contracted cost (for out of network) UP TO $3000 out of pocket. Then TriCare covers the rest.

    www.tricare.mil breaks it all down.

    Anne

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  • SoCalLisa
    SoCalLisa Member Posts: 13,961
    edited September 2010

    Anne, how about Tricare for Life with Medicare??

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  • SeaKris
    SeaKris Member Posts: 1
    edited September 2010

    I guess I'm lucky that I'm active duty... I had silicone recon, but everything was covered 100% including having a recvision for larger implants and having lipo/fat grafting... Good luck!

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  • pita17
    pita17 Member Posts: 2
    edited September 2010

    I just had bilateral mastectectomy & tram flap recon & Tricare standard is supposedly covering it all.  I found out today that they don't cover the Oncotype DX test fromGenomic Health. Fortunately Genomic Health has a patient assistance program as this test is $4000. I think its absolutely horrible that Tricare Standard will not pay for this test to determine if I need Chemo

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  • SoCalLisa
    SoCalLisa Member Posts: 13,961
    edited September 2010

    Me too

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  • Mariposa109
    Mariposa109 Member Posts: 61
    edited October 2010

    I ended up switching from prime to standard, and now I am waiting to find out how much I will end up paying with NOLA. Pita I am glad you didn't have to pay for the test, I would think that test should be considered medically necessary and insurance should cover it! Thank you everyone for your help!! I was really lost as to what to do and where to look.

    ((HUGS)) Mari

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  • Mariposa109
    Mariposa109 Member Posts: 61
    edited October 2010

    I ended up switching from prime to standard, and now I am waiting to find out how much I will end up paying with NOLA. Pita I am glad you didn't have to pay for the test, I would think that test should be considered medically necessary and insurance should cover it! Thank you everyone for your help!! I was really lost as to what to do and where to look.

    ((HUGS)) Mari

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  • AnneW
    AnneW Member Posts: 4,050
    edited October 2010

    With TriCare and NOLA, you should be able to have the surgeon you want, but the surgery itself will not be at the Center--it will be at Fairway in Slidell. Pre-ops, post-ops, and limo rides will be through the Center, though.

    Lisa, I don't know about TCforL/Medicare...

    Anne

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