Anyone have Tricare Insurance?

[Sandybells 0]

I had my lapband surgery Feb 23, 2005. At that time, neither Medicare or Tricare would preapprove so I had the surgery and promised to pay if they did not pay. It was a gamble at the time. (But in the end I did not pay a penny.)

Recently, we saw one of the nurses that head up the program and she said both Medicare and Tricare are on board with paying for surgery. What criteria they use I don't know but I think if you have two comorbidities and are around 35 BMI +... you are very likely to be covered. I started out at about 211 pounds and 5' 2". Now I am down to 134. I am scheduled for panniculectomy June 26th, 2008. Again, I don't know if either will pay but it is going to be done and hope they do pay. My surgery involves no muscle tightening. Just remove excess skin. No liposuction. It will cost about $5500 total here in Minnesota. Hope this information helps someone out there.

Sandy

[paganndamaged 1]

So I figured that I'd check and see if Tricare had gotten a chance to look at my referral since it was sent in friday morning and its posted and Approved!! I have to see a doctor in Austin so thats not bad at all. Its a lot closer the Dallas. I wanna just jump around and do the goofy happy dance. Although my husband wasn't impressed I"m thrilled.

[Fdiljn 0]

Super!! Please keep us updated on your progress

[IntoLess 0]

There is Scott and White in Temple, call Tricare and see if they will change it to them.....much, much closer.

I am seeing Dr Ganta in Austin, and he seems to be a very good doctor, as I have only seen him once. If distance is important, Tricare will change doctors for you.

[HF2008 0]

Hey Locals...

Loving Tricare right now!!!!!!! :thumbup: I am due to be banded on June 2, Before you decide if you want to be banded in Temple or Austin, take into consideration your motivation.

I went to a seminar in Temple, and made tons of phone calls. Also, I went to Austin, and compared the two offices. And I am going with Austin, because on the phone, Temple office is impatient and rude. In the Temple office they are scheduling surgeries for sometime around August. In Austin, it took me all of one month to get all my testing and be banded on Monday. Scott&White, you have to do a 2 week pre op liquid diet vs my surgeon in Austin requires a low carb-high protien diet. I am not banded yet and can't see drinking to get full and NO food for two weeks. But ultimately the choice is yours.....I would go to a seminar in Temple and Austin and go with the warm and fuzzy feeling. LOL! Basically whomever you feel comfortable with performing your surgery.

I was just ready to get it over with and after speaking with the Austin surgeon they had me moving right along. When you have to see a psych for your evaluation. Do not pay the out of network fee charged by the hospital.....find a psych who accepts Tricare and call Value Options and they will do the referral right on the phone. I went to visit my psych in Austin because the ones in Temple were booked through July. Our area is just too small, and Austin has more choices so you don't have to wait 2-3 months to complete everything. Also I have only made 2-3 trips to Austin so it's not that bad. I scheduled my psych appoinment for the same time frame as my pre op testing and made a day of it. So I said all this to say closer facilities really shouldn't be a determining factor.....Go with how YOU feel!

[meglaulanmar 0]

I got a referal for Walter Reed today. Then I called tricare (because the doc said I didn't really meet the criteria, but she put the referral in anyway. Tricare said w/ the new rules I can get in done at a MTF w/ no involvement from them whatsoever or I could go off post and get it done at a civilian doc. of my choice as long as they accept tricare prime. With the civ. doc I have no copay and no deductible. I am going to call for the referral in 2 days and in the mean time search for a doc that accepts tricare around here in case they are too backed up at Walter Reed. I am sooo borderline. I would be approved most places as I am at a 38 bmi w/ several comorbidities, but this tricare 100lb thing has me freaked as I am 100lbs over my "low end" ideal body weight but not 100lbs over my "high end" ideal body weight.:confused2:

[IntoLess 0]

I got a referal for Walter Reed today. Then I called tricare (because the doc said I didn't really meet the criteria, but she put the referral in anyway. Tricare said w/ the new rules I can get in done at a MTF w/ no involvement from them whatsoever or I could go off post and get it done at a civilian doc. of my choice as long as they accept tricare prime. With the civ. doc I have no copay and no deductible. I am going to call for the referral in 2 days and in the mean time search for a doc that accepts tricare around here in case they are too backed up at Walter Reed. I am sooo borderline. I would be approved most places as I am at a 38 bmi w/ several comorbidities, but this tricare 100lb thing has me freaked as I am 100lbs over my "low end" ideal body weight but not 100lbs over my "high end" ideal body weight.:confused2:

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.

[HF2008 0]

I got a referal for Walter Reed today. Then I called tricare (because the doc said I didn't really meet the criteria, but she put the referral in anyway. Tricare said w/ the new rules I can get in done at a MTF w/ no involvement from them whatsoever or I could go off post and get it done at a civilian doc. of my choice as long as they accept tricare prime. With the civ. doc I have no copay and no deductible. I am going to call for the referral in 2 days and in the mean time search for a doc that accepts tricare around here in case they are too backed up at Walter Reed. I am sooo borderline. I would be approved most places as I am at a 38 bmi w/ several comorbidities, but this tricare 100lb thing has me freaked as I am 100lbs over my "low end" ideal body weight but not 100lbs over my "high end" ideal body weight.:confused2:

No need to be nervous....I am sure you will be assigned a patient advocate who will work on your behalf to get you approved. Believe me they will work everything out for you to get approved as long as you meet the requirements and I am sure LOW/HIGH will not make a difference. It's ok Breeeeaaaath! An advocate will work FOR YOU!!!!! Again, goodluck!

Tricare is easy.....they don't have a pre op diet or anything...My process was about 1 month from referral and it wennnnnnnnt so fast! It will work out.....I am sure of it!

[Ineedalapband 0]

HF2008, how did your surgery go? Also, can you tell me how long it took from the time the Dr. office put in the request to Tricare for the surgery until you got the approval? Curious minds want to know. :biggrin2:

[HF2008 0]

HF2008, how did your surgery go? Also, can you tell me how long it took from the time the Dr. office put in the request to Tricare for the surgery until you got the approval? Curious minds want to know. :biggrin2:

Approval takes no time at all .... you know you can check the status @ www.humana-military.com and I was checking like every 5 minutes or you can call and go through the automated system. With Tricare though, you have to get approval to visit with the surgeon and then they send in your information for approval to be banded and each referral takes about 2 days to be approved, and sometimes it can be done the same day.

My surgery was ok...

The first day I went in about 10 ish and was done by about 3pm, after recovery and tests. I went to Target to get my medication filled and picked up some groceries. Then I went to the hospital to visit my neice who was born on the same day. Once I got home I tried to eat a little something because I hadn't eaten since the day before, and I couldn't finish a Jello cup. Because I was swollen......

The next day, I got up and tried to move around but I didn't make it very long, I started feeling really bad. I laid in bed for about 6 hours, and then I got up and walked around the block. After I finished, I passed all my gas, and had a bowel movement for the first time, and I broke out in a cold sweat and was trying to run from the restroom but it wasn't so bad when I finally accepted it. Because, what you can you really expel but liquids when you are on a liquid diet?

So over the next few days, it got better and better each day. The pain eased and eased by each passing day. I wasn't at full speed but it was getting easier as the days passed. I would say my pain finally subsided on today.....

There were nights where I was in shock like why did I do this to myself and I am still dealing with that.....But, it's very important that you find a support group to walk you through the steps. Because I have never felt like I was an emotional eater. But I am finding, I was! It's very emotional to go through the day without my guilty pleasures. I feel like I want them but there is no room for it! So I can't even indulge if I wanted. I am dealing with it best I can but I promise you if you are anything like me .... it's a battle!

Anyway, I guess I have rambled enough...Let me know if there is anything I can help you with...

[Jesusislove 26]

Hi, I am tricare prime south region and I was approved for the band on March 20, of this year. The band is now approved as of 12-2007 and is retroactive back to February of 2007. I was banded on 4-14-08. It is a change in the policy manual, but the manual may not be updated, but I called the boss in January and she said they must still honor the change. It should have been updated universally at all tricare offices. Yes it is approved if you meet the criteria.