Topic: Tricare coverage for DIEP?

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Posted on: Sep 25, 2010 12:59PM

Posted on: Sep 25, 2010 12:59PM

Mariposa109 wrote:

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!

DX 2/18/2010 IDC 4.5 cm, Stage IIB, Grade 3, 2/18 nodes, ER-/PR-/HER2- ,Lumpectomy 2/24/2010. Re-excission 2/26/2010. Chemo 4 AC 4 Taxol completed July 2010. Bmx With DIEP recon 10/14/2010. Radiation started 2/24/2010
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Sep 26, 2010 09:38AM jacee wrote:

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

My body has cancer, my spirit does not! Dx 4/27/2009, IDC, <1cm, Stage IIA, Grade 1, 3/11 nodes, ER+/PR+, HER2- Surgery 5/5/2009 Surgery 6/6/2009 Lymph node removal; Lymph node removal (Right): Underarm/Axillary; Mastectomy; Mastectomy (Right) Chemotherapy 7/6/2009 AC + T (Taxol) Hormonal Therapy 1/4/2010 Femara (letrozole) Radiation Therapy 2/12/2010 Breast, Lymph nodes Surgery 9/9/2010 Prophylactic mastectomy; Prophylactic mastectomy (Left); Reconstruction (Left): DIEP flap; Reconstruction (Right): DIEP flap Surgery 10/9/2011 Reconstruction (Left): Nipple reconstruction; Reconstruction (Right): Nipple reconstruction
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Sep 27, 2010 12:58PM Mariposa109 wrote:

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

DX 2/18/2010 IDC 4.5 cm, Stage IIB, Grade 3, 2/18 nodes, ER-/PR-/HER2- ,Lumpectomy 2/24/2010. Re-excission 2/26/2010. Chemo 4 AC 4 Taxol completed July 2010. Bmx With DIEP recon 10/14/2010. Radiation started 2/24/2010
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Sep 27, 2010 01:03PM heatherbless wrote:

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
Be faithful in small things because it is in them that your strength lies. Mother Teresa Dx 10/1/2008, IDC, Left, 2cm, Stage IIB, Grade 3, 1/8 nodes, ER+/PR+, HER2- Dx 11/6/2015, IDC, Left, Stage IV, metastasized to brain/bone/liver, Grade 3, ER+/PR+, HER2+, Chemotherapy 12/17/2015 Taxotere (docetaxel)
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Sep 27, 2010 02:06PM Mariposa109 wrote:

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..

DX 2/18/2010 IDC 4.5 cm, Stage IIB, Grade 3, 2/18 nodes, ER-/PR-/HER2- ,Lumpectomy 2/24/2010. Re-excission 2/26/2010. Chemo 4 AC 4 Taxol completed July 2010. Bmx With DIEP recon 10/14/2010. Radiation started 2/24/2010
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Sep 28, 2010 01:52PM AnneW wrote:

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

2002 IDC stage 1, grade 1, rads & AI Dx 9/18/2007, ILC, <1cm, Stage I, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Sep 28, 2010 02:43PM socallisa wrote:

Anne, how about Tricare for Life with Medicare??

Biography: DX 11/2000 LCIS,DCIS,IDC 2B, Grade 1, ER+,PR+ Her2Neg 1 pos node Lumptectomy, CMF chemo X 6 mos, DX 8/2001, IDC same breast--Mastectomy , Left Breast Lumpectomy... Tamoxifen, one year...Armidex, Four years
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Sep 29, 2010 03:28PM SeaKris wrote:

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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Sep 30, 2010 12:33PM pita17 wrote:

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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Sep 30, 2010 12:50PM socallisa wrote:

Me too

Biography: DX 11/2000 LCIS,DCIS,IDC 2B, Grade 1, ER+,PR+ Her2Neg 1 pos node Lumptectomy, CMF chemo X 6 mos, DX 8/2001, IDC same breast--Mastectomy , Left Breast Lumpectomy... Tamoxifen, one year...Armidex, Four years
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Oct 2, 2010 03:05PM Mariposa109 wrote:

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

DX 2/18/2010 IDC 4.5 cm, Stage IIB, Grade 3, 2/18 nodes, ER-/PR-/HER2- ,Lumpectomy 2/24/2010. Re-excission 2/26/2010. Chemo 4 AC 4 Taxol completed July 2010. Bmx With DIEP recon 10/14/2010. Radiation started 2/24/2010

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