IntoLess

I was approved this morning by Tricare for surgery. Now I just need to get my date. I think I will have to call them to change the valid through date though. They have it valid through the end of this week, the 27th. I have to pick my daughter up from the airport on Friday, so unless they do it this morning, I just don't see it happening this week! It took longer for my surgeon's insurance office to send it in to get approved then it took for my insurance to approve it. They had everything they needed to send it in 13 days ago, yet it went in this morning!

The doctor's office took care of everything.

MetLife scale is used by Tricare Met life ideal height weight tables references Unless otherwise specified by doctor, evertone is medium framed by default for Tricare. And you must have one comorbid for Tricare as well, like high blood pressure, arthritis of the weight bearing joints, etc. From Tricare.mil "Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints"

I think maybe it has to do with the hospital, it seems that everyone who has had their surgery at a Center of Excellence has gotten to go home, those who haven't have been required to stay overnight.

Congrats!!!!!!

The good thing about Unjury and GNC, and I am sure several other places, is that they have a no questions asked return policy. If you purchase protein powders, shakes, drinks from them and find you don't like them, take/send them back (with receipt, GNC is 30 days), and you will get a full refund.

One of the times I called Tricare I got someone who understood what I was saying, but said she didn't really have an answer for me. The only question I have is how they look at your weight compared to the scale. If the scale says 118-132, and you weigh 225 is that good for the 100 lb over requirement OR would you have to be over 232? That was my only question all 4 times I have called and no one has answered it. I have a few comorbids(arthritis (knees, ankles, hips), high blood pressure, borderline diabetic), that isn't my problem. My problem is the weight, I lost several pounds when my husband was in Iraq and am still in the process of packing it back on since he came home, so I am wondering if I should go back down and reweigh. I think I have put on another few pounds since then. Wonder if they will take my word for it? Doubt it, just thinking out loud. :smile2:

I am Tricare South, Prime. How do you get a case worker? I just called earlier this evening, just to see what the requirements were (what part of the MetLife scale they go by, high end/low end?) and still got nothing out of them. The lady I spoke with thought I was asking her to tell me if I would be approved. I am over their 100 lbs if my doctor says I am small framed (borderline on that as well), and mid range for the medium frame.I explained this to her and she told me yet again that she couldn't tell me if I would be approved or not. AGAIN, I said I was not asking her if I would be approved, I asked what the requirements were exactly.

CONGRATULATIONS!!!!! I am so happy for you. I am waiting on the psych to send my eval to the surgeon, then they will submit to Tricare. Hopefully I will join you soon.

The best advice I can give you is to call Tricare directly. Anytime I have had to change a specialist for one reason or another, they have always been helpful. Just ask for a list of bariatric surgeons in the area, research them, decide who you want for your surgeon, call and ask if they are accepting new patients, and then tell your PCM to give you a referral to that doctor.

Give Tircare a call and see what kind of answer they give you on whether you have to be on the high end, low end, or somewhere in between. I have called three times with this same question and none of the three people I spoke with gave me a firm answer. One said she wasn't really sure, wouldn't look it up and wouldn't ask a supervisor; another said she wasn't sure either, looked it up and said she though somewhere in between would be good; the first one wouldn't really talk to me because my referral wasn't in the system yet. I have had the worst luck calling them, sometimes I get the person who knows exactly what they are talking about, and other times I get one who doesn't want to be bothered with questions and won't call over a supervisor to help when they don't know the answers.

Mine took roughly a couple of days. If I remember correctly, I did the testing Thursday morning and the doctor's office had the results by Monday afternoon.

I am in central Texas, having mine done in Austin, I hope, pending approval. I do have a concern about my weight.....I am scared I will be off by just a few pounds. Actually, 7 pounds. I am hoping and praying with all my heart and soul that the surgeon's letter is written correctly to get me this surgery. IF he says the magic words "100 lbs overweight for her height and body structure", I should be fine, otherwise Tricare will lump me in the medium size frame and I will be 7 lbs short. Tricare SHOULD fax the letter to the doctor by the end of the business day of the change, meaning they should have gotten it this afternoon (probably after close since Tricare is open until 6 central and dr may close at 5). Check first thing in the morning, then call tricare back if they don't have it and ask them to fax it over, they are usually pretty good about some of that.

Good luck to you, Gina! I am pulling for you!

Okay, I have hid in the corner for a while, lurking, reading, now it is my turn. Between the ages of 10 and 11, I lost everything I knew to be true in life. My parents divorced and my brother married when I was 10, at 11 both sisters got married within a few weeks of each other, and a few months later my dad stopped making house payments so my mom and I had to move out of the only house I ever knew. I went from an upper middle class lifestyle to a lower class lifestyle and didn't know how to cope with losing my family, my home, and my friends. Government cheese and rice became my friends. Cheap hot dogs, bologna, eggs, white bread, government cheese, and government powder milk became the staples of my life. Because not only did my dad stop house payments, he wasn't nearly consistent with child support as he could have been. Mom still loved him too much to take him to court. Terrible sob story, we all cope, right? I have grown to not only forgive my dad and mom, the fight really was between them, I just happened to be an innocent bystander. I managed to stay just overweight not morbidly obese, when I graduated high school and finally started working(I had to concentrate on my grades because I HAD to go to college, right?), I would walk to work, about 3 miles each way. This didn't take the weight off as I had hoped, but did provide much needed exercise. I met my wonderful husband and went to Germany(home is where the Army sends you). This is the first time I am out on my own, so to speak. I am cleaning, cooking, doing grocery shopping, but what do I know about grocery shopping? Meat and potatoes, that is what he eats (all 6'1"--160lbs of him), he was skinny, this must be a good thing to eat, right? I did not know to get fresh fruits, veggies......I didn't have these things growing up, but I did make sure we had soda and cookies! Why not, I couldn't have them growing up because we couldn't afford them, surely my mom would have made sure I had the fruits and veggies if they were so good for me.... A couple months later I got pregnant. Beautiful little girl, now 11, name Karrington, light of our lives. But after she was born is when all the weight piled on. When she ate, I ate, when she slept, I slept, when she cried, I cried. Housework? Who has time? Exercise? You must be joking. I snapped out of the post-pardom depression when she was 7 months old, just after our trip back to the states for Christmas. But it was too late, I gained way too much weight, and my wonderful husband kept his mouth shut about it not wanting to hurt my feelings. Unfortunately, this hurt more than it helped, I thought he was okay with it, loved me the way I was, which he did/does, but he wasn't really "okay" with it. A few months ago he came back from Iraq to a wife who had lost about 40 lbs since he had left. Of course I did, we went through this the last time he deployed, and guess what happened both times. BINGO! I gained it all back. My newly found PCM told me my weight loss could be attributed to stress, and referred me to a doctor in Austin. I told my husband, he asked if I was sure if this is what I want, yes, I am sure, I need this tool. If I could do it on my own, it would have happened years ago. I just completed my psych eval, which I "passed" and am waiting for him to send it to my surgeon, from there it goes to insurance, then hopefully, my new life will begin.

The doctor asked me several questions, and told me that sometimes he will make his patients take other tests, but some he can get a good feel for right away. I guess I was one of those. I didn't have to take any other test. He was a very easy person to talk to (and even joke around with a bit).

I had the same problem with my psych eval, kind of. I was referred to one psychologist who couldn't see me, so I called to get a list of others. They gave me the list, and I called each of them, but they were all CHILD PSYCHOLOGISTS!!! I called back, told them the problem and the sent me to MENTAL HEALTH! I explained the situation and they transferred me back to the original customer service agent. I spoke with her for a few minutes, telling her who I got to replace the original doctor, and again she transferred me to mental health. Right now my referrals and authorizations page has 3 referrals to the same doctor, all for different reasons! I finally gave up that day, called back last week, told the girl my story and she kind of chuckled, and then took care of everything. I thought I was going to need mental health before it was all over with! That was an awfully long story to get to my point..........it all worked out for the best, and I passed my psych eval this afternoon. He said there was no reason I shouldn't be a perfect candidate for the band. I am so excited, his approval was all I was waiting for to get the doctor's office to turn it over to TriCare for approval.

I was told that the surgeon wants clearance from your PCM to know that you are physically able to undergo surgery. More specifically, there are no underlying health problems that may cause complications during or after surgery.

They do them at BAMC at Fort Sam Houston (I think). The only way to make sure is to make the call, but unfortunately I wouldn't know exactly who to call to find the answer.

That's great news! Perseverance pays off most of the time!

SO HAPPY FOR ALL WHO HAVE BEEN APPROVED!! This is great news for you guys! Hope all goes well.

Everyone whom I have spoken with over the phone don't seem to be the most capable. Which is why when I have a problem with them I go to the service center. Maybe I get the wrong people when I call, maybe I catch them on a bad day, but the past few times I have called, no one knew the answers to the questions I have asked. Then asking to speak with a supervisor hoping they knew the answer, I would get told that they would look up the answer (all I needed to do was switch doctors for a referral). When this happened before all they had to do was give me a list of doctors in the area, let me find one who would take me, then change the name on the referral when I call back. It took four phone calls to tricare yesterday, the first time they gave me pediatric doctors to call, once everything was straightened out, and I called them back to tell them the right doctor they put in a different referral code, and today they called me back wondering why I had four referrals to one doctor.....Maybe they aren't all morons, I will give them that, but I do seem to get the ones that are less compitent than others.

I was wondering the same thing. My surgeon has had my paperwork for about a week, the only thing missing is my psych eval, which isn't a requirement for my insurance, just him. I had to put my psych eval off for a couple of weeks as I am going in for laparoscopic surgery tomorrow for endometriosis, a D&C, and a hysterscopy. I was trying to put off this surgery until after my banding, but because they are taking their time with my paperwork, I guess it is good I decided to take this route.

After 20 million surgeries (okay a bit extreme, maybe 10), all elective I have never run across a form like that, I have always been given the standard form. I just do not understand your doctor. Surely you aren't his FIRST EVER Tricare patient. I know you are the first for the band, but he has had some dealing with Tricare before you and he knew they wouldn't cover very much of the costs. I looked at my claims sheet the other day and of the $15000 it cost for my sinus surgery (hospital, doctor, anesthesiologist, etc.), Tricare paid about $4000 of it. The doctor didn't have to do it, as it was elective, but boy am I glad he did, I haven't breathed this well in years! It is no wonder fewer and fewer places are accepting Tricare, and we (dependents) pay the price for it.

Instead of calling Tricare, since you never know what moron you will get, go to your local Tricare office. make sure you take with you your letter of approval, OR your approval number. As far as I know, the hospital has contracted ALL services provided with the insurance companies, whoever they may be, and have both parties AGREED with these terms and stipulations before entering into the contract. You cannot be turned down by the hospital, the surgeon, I am not sure about. As far as you being billed, as a Tricare Prime beneficiary, you are not supposed to be billed for anything. The insurance form you sign that says they will bill you for what Tricare doesn't pay, is a standard insurance form. As a Tricare STANDARD beneficiary you can be billed for part of the difference, I believe. IF as a PRIME beneficiary you are billed and asked to pay a difference, take the bill to your local Tricare Service Center and they will take care of it.