Tricare - Center of Excellence???

[irideaqh 0]

My primary care doctor submitted my referral to Tricare South for a consult with a surgeon for lap band. I just got a phone call from a Tricare rep and she said that they wanted to refer me to a surgeon who is affiliated with a "Center of Excellence".

Has anyone else had Tricare request this? Luckily the surgeon my doctor requested a referral with is in the same practice as the surgeon that Tricare wants me to see and I had not really had a preference of one over the other.

So hopefully all is going well and I am on track to getting the Lap band. I am very happy with how quickly Tricare responded to my doctors referral request. It has only been a couple of days.

Lisa in OK

[my2parrots 0]

I am also just starting to get approval with Tricare South. I am in Oklahoma, and I have heard about the "Center of Excellence" issue. I have an appt tomorrow with my primary physician for a referral, and I have already printed info to take with me so he doesn't have to waste any time looking for a doctor to refer me to. I am soooooo ready for this to start rolling! I'm sweating the 100lbs for frame size requirement so I'm crossing my fingers and thinking "heavy" when I get weighed tomorrow. I'm not sure how they figure that...I'm 5'4 and a half and weigh 225, so I think they could deny me. They may as well approve me, because I could gain 10 lbs without even trying! :tt1:

Waiting for a band in Oklahoma!

[Sgt Bob 1]

The hospital where I have been checking into LB told me that Tricare requires that the surgery be performed at a "Center of Excellence". I asked their insurance person where this information came from and she couldn't really tell me.

I've searched and searched at MyTricare.com and could find nothing at all about a Center of Excellence requirement for LB or anything else. I have called Tricare North several times and no one I talked to there had ever heard of it.

I have Tricare Standard and have been told repeatedly that I can go anywhere I want, as long as they will accept Tricare insurance. The requirements should be the same in all regions, although it might be different for Prime or some other coverage.

This may be something else which is yet to be ironed out, the same as with Tricare figuring out Lap Band has been covered for almost a year. I also wonder if some people their are not just telling us something they "heard" from someone else.

[wife2aviator 0]

Hi all. I just went to my PCM yesterday and she is putting in for LB referral. She said I should hear something in a few days. I am Prime and South. I seen in the waiting room this sign that said something about This Center is a Center of Excellence, but I didn't pay any attention other than that. I guess maybe I should have.

[irideaqh 0]

I am Tricare Prime, so I don't know if there are different requirements than for standard. The Tricare rep who called was very nice and had the name of the surgeon in my area that was affiliated with a "Center of Excellence" to refer me to. When I asked her how long it would take for me to know if my referral to see the surgeon was approved, she said she would take care of it right then. When I was finished talking to her I immediately checked my referral status online and it had changed from pending to approved. :biggrin:

my2parrots - where are you located in Oklahoma? My husband is stationed at Tinker AFB and we live near Tecumseh.

Lisa in OK

[my2parrots 0]

my2parrots - where are you located in Oklahoma? My husband is stationed at Tinker AFB and we live near Tecumseh.

Lisa in OK

Lisa, my husband retired from Tinker AFB, we live just south of OKC. I'm trying to get my referral for Dr. Keith at OWLO in Norman. Is that the same office you are being referred to?

[irideaqh 0]

Lisa, my husband retired from Tinker AFB, we live just south of OKC. I'm trying to get my referral for Dr. Keith at OWLO in Norman. Is that the same office you are being referred to?

Yes, my referral is for Dr. Keith at OWLO.

[mgordon1 0]

I have Tricare Prime and I went to a center of excellence hospital. From my perspective it is worth it to go to one of these facilities. It requires an overnite stay and they are more equipped to deal with issues related to weight loss. I was monitored very carefully and I don't think I would have recieved the same type of care if it was done on an outpatient basis. The hospital I was at El Camino in Mountain View California, had someone talk to me regarding aftercare, nutrion etc. They basically wanted to ensure that I had everything under control and provide me with f/u numbers for my care.

The first night after surgery, believe me, going home was not an option for me. Between the antibiotics and the pain pump, I was glad I was there. Any questions, post pm me.

[nanajo 0]

I am awaiting approval too with Tricare South.. Individual doctors are "Center of Excellence " surgeons. I have no idea what it means, but only five of the surgeons at Southwest Bariatrics in Austin are "Center of Excellennce". They have about 10 surgeons.

[irideaqh 0]

I am finally approved!! :confused:

It took about a week and I had to call Tricare several times. Since they wanted to change my surgeon due to the Center of Excellence thing, my actual lap band request from the surgeon's office was originally cancelled by Tricare since they had a hold on my PCM's referral until I authorized them to change it to the other surgeon.

Then they were saying that I did not have a referral from my PCM even though on their computer system I could see that it had been approved. After explaining that to them, the rep said that my surgeon would have to resubmit the request for lap band. Called back later and got another rep and she said that she could send it through for review, the surgeon's office did not need to resubmit. I had to do that twice before it finally ended up going into review.

The insurance person at my surgeon's office received a phone call from Tricare wanting to know if I had any comorbidities. She told them no, but that I fit into their 200% over ideal weight category. I guess they couldn't figure that out by themselves. Anyway I was approved that same day.

So, I would suggest that if you don't hear back from Tricare, keep pestering them. Like my husband always says, the squeaky wheel gets the grease.

Good luck to everyone else waiting for approval.

Lisa in OK

[Wheetsin 714]

My parents are doing the paper work thing now. They are using my surgeon, who is a Center of Excellence. When they first spoke with Tricare, they were told "Good, it will save you that much hassle" (related to the fact that they had already selected a CoE).

[irideaqh 0]

I was just researching to see exactly what "Center of Excellence" was and found the following site if anyone is interested in what requirements it takes to be classified as a "Center of Excellence" or to find a "Center of Excellence" surgeon or hospital in your area.

Surgical Review Corporation

Lisa in OK

[Emily'sDad 0]

First off congratulations on your approval Lisa!

I have made an appointment with my PCM next week to explore the possibility of LB. I had hoped to schedule a physical to discuss there. Unfortunately it is next to impossible to get an appointment for a physical on base these days.

I have a lot of backpain at night and am worried that I have developed sleep apnea. I hope these issues along with my weight 6'0" 300lbs will qualify me.

I was wondering how you all felt asking about the procedure the first time? I'm feeling a bit foolish (I know I shouldn't, but I do).

[irideaqh 0]

bradkingair - thanks for the congrats. My surgery is scheduled for March 17.

I was nervous about asking my PCM about a LB referral. I had already attended a seminar and done lots of research so I was sure that I wanted to have LB and was informed about it. I printed out information about LB and took it with me to my appointment. I also had my surgeon's name, phone number, etc. to give to my PCM so it would be less work for them to do the referral. She asked me some medical history questions (she has only been my Dr for about 2 years) and then said she would refer me. It was pretty easy.

Good luck!!

Lisa in OK

[minpinmom 2]

Not sure if this is completely true, or if it is just a problem I am having, but my Dr. wanted me to do outpatient, and Tricare amended the approval so that it will be inpatient. I don't know if it has to do with the Hospital is a Center of Excellence and Outpatients aren't? I couldn't find any surgery center (outpatient) on the Center of Excellence . . . Anyway, just thought I would add that bit of info for yall.