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Three phone calls and more frustration!!!

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hope2bthinr

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Ok, turns out we had to wait a while for a letter of exclusion from my primary insurance before submitting to TriCare. That took till 8/26, then review of my file, then finally it was all faxed 8/28. Great, so I'm thinking...most of these people are getting answers from Tricare within a couple days so I was patient for a few days. Then I made the first phone call. "I don't see anything here" so I asked could they verify they received the fax and they did, then told me it usually takes 1-5 business days to process, so fine. I gave it a few more days and called again. :party: They tell me to call back the next day. That brings us to today... I called this morning,they said well it's here, call back around three. I called back and the person I talked to finally determined that they were holding it for the exclusion letter from my primary ins. And she determined THEY ALREADY HAD IT!!! The entire week went by and they had what they needed all along!!! So I'm SOOOO mad, and I have to wait over the three day weekend AGAIN.

 

At least it shows on Triwest.com as pending medical review. :tt1:

 

I'm so mad at all the delays...uuuuggghhh!!!!! :angry: And why did I think that just because I got every single thing they needed for all the doctors quickly that this would be fast and simple??? What makes me madder is my deductible starts over again on October 1st so if I can't get it done before then I get to pay my deductible all over again!!! CRAPPPP!! And my surgeon is a non-network provider so who knows how much is going to come from my pocket. I just want to get done worrying about all of this and get on with losing weight. Fingers crossed till tuesday or weds. :mad:

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Ok, turns out we had to wait a while for a letter of exclusion from my primary insurance before submitting to TriCare. That took till 8/26, then review of my file, then finally it was all faxed 8/28. Great, so I'm thinking...most of these people are getting answers from Tricare within a couple days so I was patient for a few days. Then I made the first phone call. "I don't see anything here" so I asked could they verify they received the fax and they did, then told me it usually takes 1-5 business days to process, so fine. I gave it a few more days and called again. :crying: They tell me to call back the next day. That brings us to today... I called this morning,they said well it's here, call back around three. I called back and the person I talked to finally determined that they were holding it for the exclusion letter from my primary ins. And she determined THEY ALREADY HAD IT!!! The entire week went by and they had what they needed all along!!! So I'm SOOOO mad, and I have to wait over the three day weekend AGAIN.

At least it shows on Triwest.com as pending medical review. :cryin:

I'm so mad at all the delays...uuuuggghhh!!!!! :smile2: And why did I think that just because I got every single thing they needed for all the doctors quickly that this would be fast and simple??? What makes me madder is my deductible starts over again on October 1st so if I can't get it done before then I get to pay my deductible all over again!!! CRAPPPP!! And my surgeon is a non-network provider so who knows how much is going to come from my pocket. I just want to get done worrying about all of this and get on with losing weight. Fingers crossed till tuesday or weds. :mad:

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Hi I hear your frustration! Yikees Hang in there......

All I can say is yes this is so worth the wait and all the hassles classes and group meetings I had to go thru to get where I am today. It is quite a process and an exciting journey. Thanks for sharing your story. imaluckydog

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Is Tricare your primary insurance? I also have Tricare and your right with the deductible starting over in October, bummer. I'm just wondering what the total out of pocket it would cost for this surgery, after Tricare pays their part. I'm still in the thinking about the surgery part. Good Luck

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Thanks you guys. Right now I'm just going to try to remain calm and hope the surgeon can get me scheduled quickly if I get the authorization approved. And yes, I feel like feet were dragging through this whole process (except mine!) since I've been doing all of this process since April sometime. I think if I had gone through a surgical center where they could line up all the tests, nutritional meeting and psych eval in one week instead of 3 months it would have moved a lot faster. But I'm going through a surgeon my primary doctor recommended, who is not a Tricare provider and not up on their requirements, the surgeon isn't a Tricare provider either, so its all gone slower than necessary. Had I known it would be this way I would have gone to one of the weightloss surgical centers that have the routine figured out and are Tricare providers. Tricare is not my primary ins, that's why I waited for an exclusion letter from my primary insurance (which was Aetna, my employer chose to have that exclusion), like I said. Luckily, Aetna paid for some of the testing because the conditions I have warrant them whether I were to get the LapBand procedure done or not. Anyway...on with the waiting game.

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