My wife just had her surgery today (5-4-09). She was fully covered by Tricare Prime (Remote), but it was not an easy task to get there. After the request was submitted by the surgeon, Tricare called and said she would only be covered under the "Point of Service" plan (50% covered) because she didn't have a referral. But, we DID have a referral from her original doctor.
So, she argued with them, resubmitted the referral and was approved, then disapproved by a higher supervisor. Finally after a rough pre-operation week of liquid diet coupled with Tricare stress, she finally got the head supervisor to sign off on it - everything except the only pre-op doctor's visit. We decided not to argue that piece ($200 after insurance) in order to not jeopardize the rest of the approval ($20k+).
Tricare is good insurance - once you figure out the bureaucracy.
My wife was covered under the 100lbs over and two co-morbids.
