NEW MEMBER IN CA- JUST GETTING STARTED

[MsKinthedesert 19]

Hi, all! I have had orientation with my wls clinic and they think they can get Tricare, my insurance, to approve me. My BMI is well over the minimum (51) I have a couple of co-morbids (that I know of), so I am hopeful. The surgeon ( not Tricare) is requiring a sleep study, which I am having next week BUT Tricare is sending me somewhere OTHER THAN my selected clinic. If it continues this way for all my pre-op stuff, I think they may send me to another surgeon or possibly a MTF (which I am trying to avoid) to get my band. Does anyone have any input to offer from experiences with Tricare?

[quileness 0]

Hi, all! I have had orientation with my wls clinic and they think they can get Tricare, my insurance, to approve me. My BMI is well over the minimum (51) I have a couple of co-morbids (that I know of), so I am hopeful. The surgeon ( not Tricare) is requiring a sleep study, which I am having next week BUT Tricare is sending me somewhere OTHER THAN my selected clinic. If it continues this way for all my pre-op stuff, I think they may send me to another surgeon or possibly a MTF (which I am trying to avoid) to get my band. Does anyone have any input to offer from experiences with Tricare?

Hi there. I have Tricare Standard and found the approval process to be very easy. As with most surgeons, you will have to go through several screenings, including a sleep study, seeing a dietician, a psychologist, etc. Tricare may also force you to do a 6 month monitored diet program (although I did not have to do this). I went through several months of these pre-op meetings with my private physician, and received a letter from Tricare saying I was approved for surgery, but only at a MTF. It typically will default back to a MTF once approved.

I was very upset, considering all of the time I had invested with my current surgeon. I called Tricare and spoke to a supervisor, explaining that all of my pre-op was done at a private office and that I did not want to go to a MTF, and it went through a second (very brief) approval process before they gave me the okay to have the surgery with the physician I had been working with all along. I was very pleased with him, and would never have wanted to do this through a MTF if avoidable. I believe the MTF basically reviews submissions and ASKS that you come to them for surgery. With Tricare Standard, however, you do have the choice of going elsewhere and they should approve you.

So, if you ever receive a letter stating approval for a MTF, know that it can be worked around with a little effort. If you have Tricare Prime, however, I don't know what to tell you. I basically received a bill for $27,000.00 from the hospital...my co-pay was $25.00. Tricare is pretty wonderful about this surgery!

Also, if all else fails, you can get great treatment at a MTF. Just make sure you research the doctors and choose the one you feel is best qualified. It may not be your first choice, but it's better than giving up entirely.

Best of luck to you!