Newbie with LOTS of questions.You've been warned :)

[lolololola 0]

Hi!

My name is Anette. I'm new to this website and I've began my lap-band®® journey a week ago. I have tricare..which might as well be in Mandrin because I do not know a single thing about getting approved thru my insurance. If anyone knows anything about tricare west please let me know.

Stories are also welcomed.

I got my refferal from my PCP friday and i've been to the semirars and had a wonderful surgeon. so what's next?:biggrin:

[conservachick 0]

Hi!

Sorry, I can't help you with the insurance part of it... I was a self pay patient!

Just wanted to wish you luck and congratulate you on your new journey!

Hope it all works out for you! Keep us all posted!

HUGS

:smile:

[GipsyGirl 6]

take your insurance card and call toll free number. Then ask them if you have beriatric surgery exclusion. If you do there is nothing you can do. If you dont have an exclusion you should connect with your hospitals finance department and they will tell you what your insurance requires.

It all depends on your insurance requirements. Mine made me go to psychological evaluation, and to get a referral from my doctor saying that I would be a good candidate, then they faxed all the oaoerwork straight to the hospital and hospital submitted the papers to the insurance company. ( But first you have to call your hospital of choice ( the one you went to a seminar at/ or any other - they accepted me even though I went to another hospitals seminar ) and then they will refer you to a financial department where you will give all your insurance information )

Soooo... Good luck! :smile:

[L12 13]

What kind of Tricare do you have? Standard, Prime, Reserve Select... Also, did you check with Tricare to verify that your surgeon is approved for Tricare? I found that just because a doctor accepts Tricare, doesn't necessarily mean that Tricare will cover the surgery with that doctor.

If you have Prime, you need to go through your PCM for a referral.

If you have Standard or Reserve Select, you won't have a PCM and don't need a referral; you just need to find out what the surgeon wants from you next--probably past medical records (especially for any comorbidities), bloodwork, psych eval, things like that so they can submit you to Tricare to get authorization for surgery.

I wouldn't really trust a hospital or doctor with knowing the requirements for Tricare without checking myself. Tricare's requirements are much easier than most other insurance, and some hospitals are clueless about that, AND about the differences in the types of Tricare. Plus some doctors have additional requirements that go above Tricare's; Tricare doesn't require a six month diet, but some doctors will still require you to do one anyway.