Frustrated with Tricare West!! Help!!!

[roedayo 0]

Hello everyone! My name is Roe Anne and I am new here. I was banded by Dr. Carpenter at Scott and White Hospital in Temple, Texas on July 8th. Not long after that my husband got orders and we moved to Fort Leavenworth Kansas. I went to my PCM and got a referral to go to Dr. Malley in KC to get my fills. Well, Tricare has denied my referral for a fill! Ugh. Tricare paid for my surgery and now they are denying me a fill. It is insane! Anyone else ever had something like this happen? Shoot, I can't even get into Dr. Malley for my first fill until Nov. By that time, I am going to be HUNGRY!!

[Shay7997 0]

I would pick up the phone and call Tricare to find out exactly why you were denied. They have to tell you. I'm on Tricare south, but I haven't had this issue yet. My husband and I are moving soon so I'm liable to have the same issue. But usually you can get the problem taken care of by talking to them.

Good luck!

[JJs_email 0]

I agree with Shey, pick up the phone and call. TriWest is usually really good and I'm sure you'll be able to get the issue settled quickly by talking to them. Sometimes it is as simple as the doctor not putting the correct information on the form.

[Ondine 1]

The impression I got from my doctor was that this is not all that uncommon. My surgery was covered by my insurance, but he warned me beforehand that many insurance companies DON'T cover fills, even if they covered the surgery - I'm still in my 3 month "free fill" period so I haven't had to submit any claims yet to find out if mine will be covered or not.

[Shay7997 0]

The thing is, Tricare DOES cover the fills. They have covered all of mine, and even a partial unfill I had a couple months ago.

But let me also add, I am on Tricare Prime. So if you're on standard, it might be a different story.

[Mimilou2004 13]

I have Tricare Standard in the South Region and fills have been covered on a cost share basis for almost 2 years.

Mimi

[eadreel 0]

Call TriWest and ask. Is that doc on your current provider list and is he taking new patients?

[roedayo 0]

Well, it has been several months since I wrote this post and I am still fighting with Triwest. They have yet to approve my fills, even though they have been sent all the paperwork they could possibly need to show them that I had the surgery and it was paid for by tricare. My dr's office has told me that if I don't get it straightened out soon, I will have to go self-pay, because they have already had to eat the cost of two fills, because tricare would not approve the charges. It is very frustrating!!!

[missgypsy 1]

Well, it has been several months since I wrote this post and I am still fighting with Triwest. They have yet to approve my fills, even though they have been sent all the paperwork they could possibly need to show them that I had the surgery and it was paid for by tricare. My dr's office has told me that if I don't get it straightened out soon, I will have to go self-pay, because they have already had to eat the cost of two fills, because tricare would not approve the charges. It is very frustrating!!!

just a suggestion since you can't get anything done on the phone or with your dr and the paperwork, how abou going down to the tricare office in the hosp and talking to them. they can tell you what to do and also i would go over to the referral office and talk to them. if you still can't get anything done go talk to the patient advocate. yes just to get the band i had to do all of that. and i ended up speaking to the director of tricare south in person. i didn't care at that point but heads were going to roll. something i just noticed you had tricare and now you have triwest? and this is because you moved correct?

[roedayo 0]

just a suggestion since you can't get anything done on the phone or with your dr and the paperwork, how abou going down to the tricare office in the hosp and talking to them. they can tell you what to do and also i would go over to the referral office and talk to them. if you still can't get anything done go talk to the patient advocate. yes just to get the band i had to do all of that. and i ended up speaking to the director of tricare south in person. i didn't care at that point but heads were going to roll. something i just noticed you had tricare and now you have triwest? and this is because you moved correct?

I have met with the patient advocate here at Leavenworth. While she was very nice, she was not much help. She did talk to the higher ups at Triwest, who told her that my appeal was under review and it looked like a strong appeal, but it could take 30-60 days to get resolved. It is just frustrating, because I have done everything asked of me and they are still taking their own sweet time. We did indeed move from Trisouth to Triwest and that is the problem. I was approved for 14 fills/visits before we left Texas.

[missgypsy 1]

I have met with the patient advocate here at Leavenworth. While she was very nice, she was not much help. She did talk to the higher ups at Triwest, who told her that my appeal was under review and it looked like a strong appeal, but it could take 30-60 days to get resolved. It is just frustrating, because I have done everything asked of me and they are still taking their own sweet time. We did indeed move from Trisouth to Triwest and that is the problem. I was approved for 14 fills/visits before we left Texas.

and how long has it been since they started the review? that is absurd!!! hope there isn't a real great BIG EMERGENCY!! shouldn't all tricares be the same? just split up so one west, south, north isn't all bombarded at once? my advocate here wasn't much help either and thats why i went over her head. we just happened to go to a conference and they had venders there and humana tricare was there so i thought hey what can i loose lol. just so happened it was the director. my prob is that they wouldn't give me a second opinion and denied me after i met ALL requirements and they woudn't let me talk to the dr in charge of my case, they also lost all my paperwork and toldme i had to start all over. they HAVE to give you a second opinion and it has to be done off post. i just found out a few wks ago that they stoppped all lap-band surgeries here at ft sill, oklahoma because they have had so many complaints and too many ppl coming back with probs. so now everyone is being seen off post. automatic off post referrals. i wish you luck. and me personally i'd start bugging the crap out of them. and i'd go down to the referral office. talk to someone and explain to them that you need the referral because you are starting to have probs. yes lie a touch if you need to- how are they going to know??? lol hey it can't hurt.