Military/tricare question - indirect

[Wheetsin 714]

Hello all,

My parents recently switched from their civilian policy to TriCare Standard, in hopes that LB would be covered... it abolsutely was not covered with their civvy policy. I gave them the codes to call with and they were told it's not covered due to "experimental" rating.

They kind of don't know what they're doing, they're lost when it comes to the online world, so I read through every post I could find around Tricare, MTFs, etc. And then tried to summarize the information to them.

I have a question though. What's "PCM"? I get that MTF = military treatment facility, but saw a lot of reference to a "PCM" as a key factor in getting approval, and I have no idea what that is. And when I relayed the info to them, they didn't have any idea either.

My parents had been on a civvy policy for about 12 years, and only used their military hospital for prescriptions. Is PCM like a PCP?

How would they "get" a PCM?

[MEW 0]

PCM= Primary Care Manager

[Dragonfly 0]

wheetsin,

PCM stands for Primary Care Manager which would be your listed Physician. I too have tricare and was told absolutely no way would it be covered but they will cover gastric bypass. I am told that all that may change in 2007 so keep checking with them. Paula

[ShereeVT 0]

No change yet with Tricare -- as of this month, they still don't cover Lap Band...but will cover by-pass surgery.

[orrn 0]

I'm in the process of getting a referral off base. Will keep you posted.

[orrn 0]

Well I'm keeping my fingers crossed, kinda scared to get my hopes up, I JUST GOT MY AUTH LETTER FOR TRICARE TO SEE A SURGEON!!!!!!!!

The letter was not for the Dr I had gone to the seminar for (which was the only one in my insurance book) (So they say!) will call in am to see what is needed now.

[ShereeVT 0]

Well - I had a call from California yesterday stating that since Tricare does not cover the surgery, they will not cover the fills either. I had my band placed end of Jan and my first fill yesterday....all out of pocket. But still trying to get Tricare to get with the program like all the other insurances. I believe Tricare is the last holdout. Good luck and let me know what happens...at least it is nice to know that there are two fighting this battle!

[orrn 0]

I have an appt for the Dr. I chose, under tricare, April 16. Alot of people are saying no tricare doesn't cover but I still feel I need to hold out and do what I can and I guess, hear it from the horses mouth, before giving up!!!!