TRIWEST process...????

[Navywif99 0]

Im just in the begining stages of considering Lap Band Surgery. I have Tricare West Insurance and wanted to get some information on the process to get approval. Do I need to see my PCM for a referral? Is Triwest quick or slow to approve? Any information is helpful.

Seminar is on April 23 with Dr. Malley in Kansas City

[Dave_NW 92]

Triwest is a Regional part of Tricare insurance. Depending what sort of Tricare coverage you have, you may need a referral. Some types don't need a referral. Call them and ask what they require: http://triwest.com/ 888-TRIWEST (874-9378) I have Tricare Prime, and did need a referral. My surgeon says Tricare is one of the easiest insurance carriers to work with, if you meet the requirements for surgery. (Their requirements are very specific.) From the day my surgeon submitted the request for me to have surgery, till I had my approval (over the phone) was three work days. VERY fast!

Good luck!

Dave

[MrsMoretti 0]

Im going through the same process I have tricare prime and i have done my 4 Apts that were required and got my refferal approved by my PCM ,Now Im just curious if you guys know if I will be approved because Im a BMI of 39.8 with nothing else wrong with me besides bad joints and being depressed ....Just short of 40BMI do you think i will be approved? PLEASE HELP I cant wait to find out.....??

[Navywif99 0]

Ok Im already freaking out!!! 4 appts just to get the refferal...what where the appts for? Are you at Fort Leavenworth? I have my appt on Monday for a referral but I didn't know anything about all these extra appointments as I have my consult meeting with my surgeon on Wednesday next week an don't think I have enough time to do that many appts. I do have a BMI of 42 but I dont have any comorbities. I do have sore joints and PCOS with insulin resistance but those arent comorbities unfortunately. What I can tell you is that I have seen many people get approved on this site that didnt have comorbities some were denied the first time and sometimes even twice but they apealed and got approved so you might have to do that as I might as well.Have you been to a seminar yet? Do you have a surgeon consult scheduled?

Im going through the same process I have tricare prime and i have done my 4 Apts that were required and got my refferal approved by my PCM ,Now Im just curious if you guys know if I will be approved because Im a BMI of 39.8 with nothing else wrong with me besides bad joints and being depressed ....Just short of 40BMI do you think i will be approved? PLEASE HELP I cant wait to find out.....??

[LVGirl 4]

I got my referral to the surgeon, went to the seminar, had a follow up appt today with my PCM where I was officially diagnosed with high BP and put on meds (the surgeon's office said I should be approved because I am at least 100 lbs over + high BP) and I gave my doctor the list of bloodwork tests that I need drawn and they are sending that over to the lab for me. I go back in 2 weeks for my referral for chest x-ray and ekg and then back in 4 weeks for my surgery clearance. I have my psych eval through my surgeon on Wed. I am praying that things go smoothly so that I get approved and have surgery before the summer!

[Navywif99 0]

Thanks for all the info. I had my Dr's appointment for my referal today and it went great. The doc just verified that I actually qualify per Tricare's rules and I do and so he refered me and that was that. Guess I got lucky and didn't have to do all the extra visits. I wish Tricare paid for the gastric sleeve I might have chose that over the band since I am moving in Dec and I have learned from this website that it will be difficult to find a doc to do my fills since a lot dont like to do fills on patients they didnt put the band in themselves. Oh well....meet with my surgeon on Wed. hope everything else falls into place just as easily...

[Dave_NW 92]

Thanks for all the info. I had my Dr's appointment for my referal today and it went great. The doc just verified that I actually qualify per Tricare's rules and I do and so he refered me and that was that. Guess I got lucky and didn't have to do all the extra visits. I wish Tricare paid for the gastric sleeve I might have chose that over the band since I am moving in Dec and I have learned from this website that it will be difficult to find a doc to do my fills since a lot dont like to do fills on patients they didnt put the band in themselves. Oh well....meet with my surgeon on Wed. hope everything else falls into place just as easily...

Tricare will pay for the sleeve. But you have to have it done at a military base hospital. Here in Washington state, they do the sleeve, bypass, and banding at Madigan Army Hospital. That isn't convenient to where I live, so I opted to get the band instead at a civilian hospital closer to my home.

If you really want to get the sleeve, make some phone calls. It may be easier to do than you think.

Good luck!

Dave

[MrsMoretti 0]

Hello Everyone, I have Tri Care Prime. This is what my journey so far has been like. I had to go to my PCM to get a referral to see a surgeon , So I got my referral I called to make an Apt with the surgeon and I found out that I had to attend a Free seminar first before I could schedule an Apt with the surgeon. So I went to the free Seminar and while I was there the bariatric coordinator told me that she was going to get the process started for me and she told me what I needed to do from there on out so what I had to do was make 3 Apts with other Dr.’s that Tri Care requires you to go to which were 1. See a Bariatric Dr. he basically just asks you about your history and your health 2. I met with a nutritionist basically she just ask me what my eating habits are and told me a little bit about how its going to change with the Lap Band DUHHH no kidding its going to change right ?? LOL ….. Thinks that’s why we are all looking to get the surgery because we need a change in our lifestyle 3. Was a Phyc Apt. Just making sure your really ready for this lifestyle change and making sure that you will be able to handle it. Then after all 3 Apts you schedule your Apt with your surgeon. I met with him he did some paper work told me that I am boarder line where im supposed to be for tri care to approve me I’m 5’5 235.6 when I got weighed in at his office. Going by what everyone else says that Tri Care uses the Met- Life weight chart (med frame) which says you should weigh 127-141 for my height So that should put me at 200% over my ideal weight Im PRAYING that I get approved …. So I’m all done with my appointments with Dr’s but I still need to attend a class where they tell you all about how your lifestyle and eating habits will change after surgery I heard that this class is mandatory in getting approved for surgery . So I will be attending that class May 10^th 2011 , after that my bariatric coordinator is going to submit all my paper work to tri care and hope I get approved….. If anyone else is around the same height and weight as me and got approved or has a similar story and didn’t get approved please let me know. I also have a bad back and joint pain along with anxiety I don’t know if that will really help my case much, Please reply and give me any input you may have and I hope I was helpful for any of you who are just getting started in the process . Oh also Since I was boarder line where I was supposed to be my bariatric coordinator told me that I should get a support letter from my PCM saying that I have tried other weight loss diets and didn’t have success and that I have a bad back and anxiety and he thinks that by me having the surgery it will help with weight loss and will help with my back pain…. My bariatric coordinator told me that having a support letter it will only look better for you getting approved … I also had to get an EKG and chest X-ray done before my PCM would write the letter he wanted to make sure I was healthy enough for surgery ! …. So that’s all so far hope I helped maybe you all can help me and let me know what ur process was like

Thanks

[LVGirl 4]

Thanks for all the info. I had my Dr's appointment for my referal today and it went great. The doc just verified that I actually qualify per Tricare's rules and I do and so he refered me and that was that. Guess I got lucky and didn't have to do all the extra visits. I wish Tricare paid for the gastric sleeve I might have chose that over the band since I am moving in Dec and I have learned from this website that it will be difficult to find a doc to do my fills since a lot dont like to do fills on patients they didnt put the band in themselves. Oh well....meet with my surgeon on Wed. hope everything else falls into place just as easily...

The extra visits are for labwork, chest x-ray and EKG for surgery clearance. I actually just did everything yesterday morning and should be cleared for surgery on the 11th (my PCM has really come through for me this week). Then I have my psych eval and consult with the surgeon. Hoping and praying to be approved quickly and scheduled for surgery by mid-June.

[gaarmywife06 2]

I got a referral from a PA at Munson a little over a month ago (here at Fort Leavenworth) and TriCare's referral letter suggested I see such and such doctor in Overland Park, KS. I went to them on April 11th for the consult and there they did my BMI and everything and went over the procedure, took my history, etc. They told me they were waiting on Tricare to come in and approve their facility (Weight Loss Surgical Center) to do the surgery and that if I had not heard from them within 30 days, to give them a call. Today I called them and when I was transferred to speak to someone about pre-determination, she told me they didn't take Tricare?! I was like, "WHAT?!" On TriWest site I log into, it shows me where TriCare has paid the claim for the consultation and now you're telling me you don't accept Tricare?! So I called Tricare to see what was up with that and they said that they were out-of-network but they paid the claim anyways because I did have a referral. I called the Weight Loss Surgical Center back and they said that when I came to their office a month ago, they were working with Medicare and Tricare so they would be able to do it, but they're requiring them to do extra steps. When they saw me back in April, they told to wait 30 days based on their hopes of being approved in that amount of time, however, now she tells me she's not sure when they'll be approved - if EVER. So now, I've went through a consultation and a 30-day waiting period that doesn't do me a bit of good. Now, I have to start my process all over again. My question is, who do I turn to now for the surgery? Who does TriCare approve in the area. I've been trying to find someone, anyone. Does anybody recommend any particular doctor? PLEASE HELP ME!

[Dave_NW 92]

Now, I have to start my process all over again. My question is, who do I turn to now for the surgery? Who does TriCare approve in the area. I've been trying to find someone, anyone. Does anybody recommend any particular doctor? PLEASE HELP ME!

Call Tricare back and ask them to tell you who they want you to see IN NETWORK, then make some phone calls and ask ahead of time about whether that clinic accepts Tricare, and if they are an approved surgical center. You might also call known surgical centers in your area and ask which surgical centers take Tricare. If you ask the right questions, you should be able to find out who can help you the most. You should also be able to talk to your medical center on base and ask them who does the surgery under Tricare.

I went through something similar up here near Seattle. I got a referral (at my request) to an outfit called Northwest Weight Loss Surgery. I went to their free seminar, and scheduled an office visit. When I called to discuss the scheduled appointment, I was told they'd take the payment Tricare would make, but that I'd be on the hook for the difference, which could easily be over $10,000. I said No thanks, and canceled that appointment.

Tricare then sent me to a surgeon in network who does accept Tricare. I went to see him, and had a great visit. Nice guy, and is a sleeve patient himself. It was only at the end of the appointment that I learned his clinic had not yet been approved for performing the surgery. So even though he was a bariatric surgeon who accepted Tricare, he couldn't help me because Tricare wouldn't let him do the surgery. He did offer to do my aftercare and fills, if I wanted him to.

That surgeon was the one who gave me names of other surgeons in my area who performed the surgery. I called them and asked whether they took Tricare as full payment for surgery. I found one I'd heard of, did my research, and finally I was on my way. i wasted three months with this rigamarole. But once the ball started rolling, thigns went smoothly.

Good luck!

Dave

[Navywif99 0]

I got a referral from a PA at Munson a little over a month ago (here at Fort Leavenworth) and TriCare's referral letter suggested I see such and such doctor in Overland Park, KS. I went to them on April 11th for the consult and there they did my BMI and everything and went over the procedure, took my history, etc. They told me they were waiting on Tricare to come in and approve their facility (Weight Loss Surgical Center) to do the surgery and that if I had not heard from them within 30 days, to give them a call. Today I called them and when I was transferred to speak to someone about pre-determination, she told me they didn't take Tricare?! I was like, "WHAT?!" On TriWest site I log into, it shows me where TriCare has paid the claim for the consultation and now you're telling me you don't accept Tricare?! So I called Tricare to see what was up with that and they said that they were out-of-network but they paid the claim anyways because I did have a referral. I called the Weight Loss Surgical Center back and they said that when I came to their office a month ago, they were working with Medicare and Tricare so they would be able to do it, but they're requiring them to do extra steps. When they saw me back in April, they told to wait 30 days based on their hopes of being approved in that amount of time, however, now she tells me she's not sure when they'll be approved - if EVER. So now, I've went through a consultation and a 30-day waiting period that doesn't do me a bit of good. Now, I have to start my process all over again. My question is, who do I turn to now for the surgery? Who does TriCare approve in the area. I've been trying to find someone, anyone. Does anybody recommend any particular doctor? PLEASE HELP ME!

Im not sure who you saw in Overland Park but I go to Malley Surgical with Stephen Malley and Dr. Ferring they are in the same general area off Lamar. We live so close so it took me awhile to find out if he was covered cause he was listed under general surgeon. I wasn't able to find any listing under tricares bariatric "find a dr" so someone on here suggested I look by his name rather than specialty. And I found him.

I would check out there website www.mallleysurgical.com you will find that he is one of the best in the country and is a representative for Allergen and teaches other Dr.'s how to do the procedure. So I feel confident in their ability to keep me alive...I compare them to a well oiled machine they will guide you every step of the way and wouldn't lead you on like the other place you went too. Also the seminars are free and you can sign up on the website so you can go asap. At the end of the seminar you will be able to make a consult apptointment. I had my consult on the 4th with Dr. Ferring she is so kind and easy to talk to and I am enjoying working with her so far and they told me they would call in a few days and let me know what Tricare requires before approval. She said I needed a psych eval and a letter from my pcm explaining that I am 100 lbs overweight with asthma and diabetes and how my life will be better if I have the surgery and lose weight. I was surprised that was it. I saw Dr. Hand at Munson so I am hoping to see him again for the psych referral and to get the letter of medical necessity. After they receive all that they will send it to Tricare for approval and it usually takes up to 6 days she said. Dr. Ferring said that after the insurance approval they can get you into surgery pretty quickly so if you get started with them you will go quickly. You will still need another referral for the consult but I didn't have any probleIms getting it.

I was surprised the nurse that checked me in at Munson was going to have wls and she said lots of people at the hospital have the band or have had wls in some form or another. I was shocked....guess I didn't realize more and more people were doing it.

If you have any questions or vent please feel free to send me a personal msg. Good Luck you'll bet back on track.

[gaarmywife06 2]

Ha! I finally found your response! Thanks! Going to start with them. Only problem I have right now is that I'm heading to Georgia for a visit at the end of this month and won't be returning until the middle of July.

[crafty mama 0]

So do any of you know what military hospitals have bariatric clinics? I have looked all over the internet and I can't find any except for Balboa. THX