I got a referral from my PCM.. I had to attend a seminar and then from there schedule an appointment with dr. office.. the office I went through really did a lot of the insurance work for me.. I was approved right away.. I think out of pocket I paid close to 400.00 ( 200.00 for initial first visit, 25 for fitness visit and there were a couple of other things i had to pay for out of pocket) after I had all my blood wok done and chest xrays tricare approved me with in 24 hours of having the drs office call.. i started the process in october, could of had my surgery in dec but we were traveling too much so I am scheduled for Jan 13th