Tricare Retiree Beneficiary Vs. Sleeve Gastrectomy

[samakar1516 1]

I read in a post on this site recently that Tricare retiree beneficiaries did not have to go through Tricare to have the surgery done in an MTF. That is not necessarily true, at least in the North Region it's not. Womack at Ft. Bragg told me that we had to have a referral put in through Tricare.

My doctor supposedly put the referral in requesting the MTF, but it came back approved for a civilian doctor, but of course Tricare does not cover the sleeve gastrectomy.

I was also told by some at Tricare that all I had to do was to call Tricare back once it was approved and tell them that I want the MTF. Well, I tried doing that today and was told that they just can't change it, they have to put a request in to see if there was space available for me at the MTF. I told her to go ahead and do that then, so now I have to wait and see if it comes back as the MTF approving it or not....what a bunch of drama!

If TRicare comes back telling me that Womack (MTF) disapproved it, I will be on the phone once again to Womack to see if there is a way I can get in there to have the procedure done. T

His is ridiculous; it's like once you've retired you're put on the back burner and basically forgotten about....which is sad.

If anyone's interested I ill keep you posted on what happens. Of course I probably won't hear anything till next week because of the holiday now.

[lovex5 25]

My husband is AD but I am going through this right now! I have a civilian pcp so no one wants to deal with me. What a total nightmare it is. I have heard so many different things. Several ladies on post said just have your pcp submit a referral. I did and of course they approved it for a civilian surgeon, even after I called Tricare to explain to them why it needs to be for the mtf not off post. Then they gave me the run around about post being full which is not true because I had called them the day before and they said they're accepting new patients. Every person I talk to has something different to say. I have been told by the mtf's bariatric head nurse just to attend the seminar and she told me Tricare has nothing to do with it. I even went to the Tricare office on post Thursday to confirm. They said if that's what she told me then they guess it's right. That didn't make me feel much better. I did find out that we have patient advocacy at the mtf here so I'll be in touch with them soon. If I have to I'll switch and get a pcp on post but I really would rather not do that. Be prepared to push because from what I've seen we'll have to.

[samakar1516 1]

I just received my approved referral in the mail yesterday for a civilian doctor. I called Tricare on Friday and they are putting in the request for Womack (MTF). WE shall see how it comes back. I will have the answer early next week, after the holiday of course. If I get no satisfaction from Tricare I will call the MTF myself and see what they say about it. Should be interesting....why does there always have to be so much drama! It's not like Tricare is paying for it themselves, especially when they don't even cover sleeve gastrectomies yet!! It really upsets me.

[lovex5 25]

It's not like Tricare is paying for it themselves, especially when they don't even cover sleeve gastrectomies yet!! It really upsets me.

Exactly!! Hope it goes well. They flat refused to help me anymore they just kept saying sorry the mtf is full.

[Finding MeMe 204]

Here on the West coast, WA/JBLM, it was an easy process. I am retired and it was done at the MTF. Since the hospital is full on post I have a civilian provider and I went to see her first. She submitted the referral to tri-care for me, I attended the classes on post and the whole process took around 9 months. Good luck and be persistant.

[Aloadoff 0]

This is the another most recent (2012) info I found on Tricare and what they cover from there manual: https://www.hnfs.com/content/hnfs/home/tn/prov/benefits/benefits_a_to_z/bariatric_surgery/bariatric_surgery_details.html

[lovex5 25]

It's weird for us because Tricare wont cover vsg but we can have it done at a hospital on post/base if the bariatric center covers it. I cant speak for everyone but my issue is i have a civilian dr off post so getting treatment at a military treatment facility (hospital on post) has been so difficult. I'm ready to self pay but i should be entitled to it like any other beneficiary of an ad/retired svc member. So, i'll wait and see.

[lovex5 25]

I meant to say if the mtf offers vsg,, not covers it.

[samakar1516 1]

I hear ya.......

I should be finding out this week if the request that Tricare put into Womack (MTF) will be approved or not. I'm keeping my fingers crossed, but in case it's not, I guess I'll be calling the MTF to see if there's anything I can do to get into their program.

I'll keep you posted.....keep the faith!

[samakar1516 1]

Here's an update....

Found out that the MTF disapproved my referral. I called the clerk at the bariatric clinic at the MTF and she said that my name never came across in the system. I don't want to drag this out, but to make a long story short....she finally called me today and told me that unbeknowst to her there was a freeze on non active duty beneficiaries because of the lack of surgeons. She has made an appointment to speak with the Col. in charge of her section to see if they can get it lifted. She said there's myself and another woman that she's trying to get in there. So if the Col. agrees she has to write a formal letter to the commander of the MTF requesting that the freeze be lifted since supposedly they can do it. I told her that the only reason why I was pushing this is because I want the sleeve gastrectomy and not the bypass, and the MTF does it and Tricare doesn't cover it for civilian health care, and that's if the civilian doctor even does the procedure.

So now it's in the hands of the powers to be at the MTF.

Keep your fingers crossed and say a little prayer for me if you would....I'll need it!

But what's going to drive me crazy is that the Army moves quickly for no one, and it could take a while before I hear anything...talk about gray hair!!

All for now,

Susan

[lovex5 25]

That sounds promising! Did you ever find out if we do in fact need a referral from our civilian pcp's? My hands are tied for another couple months when they hold the next seminar. I am crossing my fingers for you!!

[samakar1516 1]

This is where it can get a little tricky, and I think some of it depends on your MTF.

This is what I was told by the medical management team at Tricare......these were suppose to be my 2 options:

1) If the clinic at the MTF says they have room for me then just make an appointment and go.

2) If they ask for a written referral, all you need to do is get your doctor to write something up to give to the MTF clinic.

I told those 2 things to the bariatric clerk who approves the referrals, and after her doing some more research, that is when she found out that there was a freeze on us being able to use the MTF for the bariatric clinic. So that's why I'm saying that your MTF may have something to do with it, and you won't find out unless you're very persistent and ask why not.

I'm just hoping they approve it because I really don't want to get the gastric bypass if I can help it. I don't want my insides rerouted and the malabsorbtion issues as well.

Tricare needs to wake up and get with the times. The clerk told me that they've been doing the sleeve since 1998!

I think it's almost to a point of discrimination against retirees. But what I don't understand is, I can't be seen at Womack for anything, but if I do happen to go there for whatever reason, all I see are active duty and really old people.....am I missing something?

[lovex5 25]

I hate that Tricare wont cover it. I know 100% i will not do rny or band. So many spouses settle and get one of those two. Not me! Thanks for sharing your info, maybe the bariatric nurse i talked to was right. She told me tricare has nothing to do with it. I hope we both get somewhere with this soon!!

[Char 7]

When you said you read you didn't have to go through Tricare to get a VSG, you were probably reading my post. I did not mean you didn't have to go through one of the Tricare systems, only that you didn't have to go through your regular local channels if you are retired and the MTF is outside of your 99-mile zone of treatment.

There are two separate and distinct divisions within Tricare's funding sources. One serves the active-duty, MTF hospital system and the other serves anyone seeking treatment via civilian channels. It's a budget issue. The military hospital system operates on funds the government allots to the military defense budget. Tricare insurance coverage for services off base through civilian facilities reimburses hospitals and physicians is paid out from government funds allotted solely for the purpose of insurance coverage in a non-military environment.

So while you do not have to go through the normal Tricare channels if you are retired, you still have to go through the active-duty, on-base Tricare office. Instead of sending your referral to the civilian system you're used to going through, take it directly to the on-base Tricare office. Anyone wanting bariatric surgery at an MTF, active-duty or retired has to go through the Benefits Management's (Tricare) Specialty Services department office on base. The only people you bypass are the people you get stuck talking to on that 1-800# that are pretty much clueless regarding bariatric surgery, especially when it comes to the VSG.

Here's how I did it: http://www.verticalsleevetalk.com/topic/12138-tricare-prime-anyone/page__st__40__p__366787#entry366787

[samakar1516 1]

Thanks for the onfo. Char. I passed it along to the person in the bariatric clinic; got her voicemail so I left a message. But as I stated in my previous post, we just learned that Womack put a freeze on it, so it would be my guess that if the commander of the MTF put a freeze on it, it would trump all other efforts. But of course I'm not sure and that's why I passed it along...you never know. I assume that Bragg is low on surgeons and that's why the freeze. They deploy a lot of medical personnel from Bragg, which does effect retirees having things done on post.