insurance approval time and requirements

[aandbsmommy 0]

Hi. I meet my surgeon for the first time next week.. I have tricare prime and have been approved for 4 office visits with him.. Does anyone know what the wait period and requirments Tricare wants before surgery approval? also.. does anyone know if tricare prime covers the fills, etc.. thanks so much! : )

[Dave_NW 92]

Welcome! Search the forums here. There are numerous threads about Tricare Prime and getting approvals. They are one of the easiest insurance carriers to work with, and approvals are pretty fast. I have Tricare Prime, and from the time my surgeon submitted my request for surgery to the day of approval, it was three business days.

I met my surgeon twice before surgery, but still had an evaluation with him, a psychologist, a physician, a nutritionist, and an insurance coordinator. I had extensve blood work done at a lab, an endoscopy, and an evaluation with another surgeon for repairing a ventral hernia. Despite all of that, the entire process took less than three weeks. If you meet the Tricare requirements, approval will be very fast.

Yes, they pay for fills, as well as followup visits. They also paid for the entire surgery, with no deductible. My total out of pocket since starting this is less than $400. That includes copays.

Good luck!

Dave

[J9harrison 0]

Hi. I meet my surgeon for the first time next week.. I have tricare prime and have been approved for 4 office visits with him.. Does anyone know what the wait period and requirments Tricare wants before surgery approval? also.. does anyone know if tricare prime covers the fills, etc.. thanks so much! : )

Hi aandbsmommy! I have Tricare prime and was banded a week ago. Here are the things I had to do before everything was submitted to tricare..

*Referral from PCM to surgeon(Met with surgeon twice before they submitted the paperwork)

*Some blood tests

*Psych consult(needed PCM referral)

*sleep Study(needed PCM referral)

*See a nutritionist once before surgery(My only out of pocket expense of $100)

The whole process took me four months but only because the place where I was getting my sleep study done was booked for three months. Once it was submitted to them I got the approval within five business days. Tricare is pretty fast in giving you a response as long as they have everything they need. As far as weight requirements they either want 100lbs overweight with 2 comorbitites such as sleep apnea, diabetes, high blood pressure etc, or 200% over your ideal weight for your height and body frame. I have not had a fill yet but they do cover them, I think you just have to have an active referral from your PCM. If you have any questions we cant answer, feel free to call them. They are so helpful!

[LVGirl 4]

I had to attend a seminar for my surgeon (but I already had the referral approved). I went to my primary and had all my testing done on the same day (lab work, ekg & chest x-ray) and then pd $125 for my psych eval through my surgeon's office. My surgery was scheduled that day because I took everything from my my appt with my PCM to the surgeon's office. I was approved in 2 business days. I did meet the requirements of 100+ overweight and had hypertension (which I was diagnosed with less than a month before I started everything.). It was much easier than I ever imagined.

Good luck with everything!