Calling all Tricare Patients!!!!!

[Autumn2013 27]

Hey all,

I'm in the process of trying to get approval for surgery from tricare, already have the referral from my pcm...I just wanted to how everyones journey to getting approval went...And whether or not you had your surgery at an MTF or of post...Well hoping for a few responses thanks!!!!

[mommakatx2 0]

Hi Tori,

I didn't have any problem getting the referral for the surgeon from my PCP. I went in for an appointment and told him that's what I wanted, and he put the referral in the same day.

I have a civilian surgeon in a Center of Excellence in Louisville, our MTF doesn't do bariatric surgeries. The bariatric center required that I attend a seminar, nutrition consult, psych consult, and nurse consult before I could even meet with the suregon.

After I finally had that completed, I then had to have a sleep study done, a visit to the pulmonologist and cardiologist, and labs drawn. I finally finished with all the appointments on Monday. Now I just have to wait for one more lab to come back.

I'm hoping everything is submitted to Tricare by the end of this week, as we are getting ready to PCS in 4 weeks!!!! My surgeon knows this and has been great in trying to get everything done in time.

Good luck and keep us posted!

[gina s. 0]

I have Tricare also, they don't do the lapband procedure here on post so I'm going through a civilian surgeon's program. My requirements were going to a seminar, a psych eval, one support group meeting before surgery, and a consult with the surgeon's office. Then all of the info will be sent in to Tricare for approval. All I have left to do is the support group meeting and the consult, and the surgeon's office told me that after the consult all I need is approval from Tricare for the procedure and that once they get that, then they'll schedule a surgery date. So I'm going to the support group on the 21st, my consult is the 25th, and that's it until the approval and surgery.

[minpinmom 2]

I was one of the first to be approved when Tricare started with Lapbands. I got my approval from my PCM to see the surgeon. The surgeon sent in a letter of Medical Necessity to Tricare. Once they received this, I was approved within 24 hours. I didn't have to have ANYTHING else for Tricare. I had surgery on 2/19 and had my second fill yesterday!

So far I have paid :

$12 for my initial visit with my PCM

$12 for my initial visit with the Surgeon

$11 for the overnight stay at the Hospital

$12 for my first fill

$12 for my second fill

I am a pretty happy camper!

[1000words 0]

minpin-

Were you Tricare Prime or Standard?

[minpinmom 2]

I am Tricare Prime.

[H8thew8 0]

I have Tricare Prime and I was banded on Monday by Dr. Ellison at the WTLSC in Overland Park, Kansas. A word of advice to all of my military family, when you get your approval make sure that the doctor's name if at all possible is not specified on your paperwork. Here is my story... My doctor, Dr. Nigro, was to perform surgery at 11:30 am, I received a call at 9 am stating that Dr. Nigro had a health condition, was in the hospital and WOULD NOT be able to perform my surgery. Because I was going through insurance, they were not going to be able to offer me another surgeon. Fortunately, I recalled that there was not a doctor listed on my referral, only the actual center. After calling to verify, I was allowed to be transferred to another doctor. I was very familiar with each of the surgeons, from my extensive internet research and was very comfortable with transferring to Dr. Ellison (who the staff calls "Dr. McDreamy" a very fitting name!:huh2:) Anyway, I had my surgery at 7:30 at night and was released right before midnight. I am little sore, but very, very happy!

[Jesusislove 26]

H8thew, congratulations. Tricare really does not require a whole lot; you either meet the criteria of being 100lbs overweight with co-morb (for short) or 200% of you weight with no co- morb. My bariatric surgeon required clearances from cardiology, PCM, pulmonology, psych eval, and nutrition eval. Tricare requires none of this, but your surgeon may. I did all this before ever seeing the surgeon, then they submitted my referral after all my clearances and I was approved quickly. I am glad they requested clearances because I have never had any surgery of any kind so I wanted to be cleared too. I was approved before my intial consult with the surgeon. Tricare is the easiest to me to get approved after reading about the other insurances. .

[armywife4life 0]

see i have tricare overseas, and the tri care lady says that at first it was easy to get the surgery but now not the case here. Im seriously worried. I got a referrel from my PCM to see the surgeon in Frankfurt Germany but first i have to have labs done and a psych test. geesh i wish i were stateside it seems like its alot less complicated to get the procedure done.

[crusin2wardsloosin 0]

hi everyone, I dicovered this forum and joined today. First time on a forum. I was very excited to see others with tricare insurance! I found a surgeon,went to the seminar, saw primary Dr. (got letter of reccomendation),got blood work done, have appt for psych eval tomorrow, then i have to make appt with the nutritionist. I am about 130 pounds over weight,with a bmi of 49,and high blood presure. The Dr's office is not familliar with the insurance and they are not sure if I am going to be required to present a 6 month supervised diet to tricare,wich most insurances require. Has tricare requested that from any of you? I've dieted but not under my doctors care the last 6 months. Atkins, weight watchers, and LA weightloss before they closed down. What exactly are their requirements?

[minpinmom 2]

Woo Hoo! You will be happy to know that Tricare does NOT require a 6 month supervised diet. They only require you to meet the weight requirements. Either 200% over your ideal weight (according to Met Life Chart), or 100lbs over your ideal weight with co-morbidities. I wasn't required to do ANYTHING. I was approved with a letter of Medical Necessity from my Surgeon to Tricare. Hopefully it will be as easy for you!

Good Luck and keep us updated!

[H8thew8 0]

When seeking a referall with Tricare, you really have to lay it all on the line with your PCM. If all of your previous weight loss attempts are documented and you are overweight with other weight related health issues, you will have no problem. Mine went through in exactly two days. Due to the weather it took me another month to get the surgery, but now all is well! Another tip is if you are fortunate enough to find a surgical center like the one I went to. No liquid diet (except for one day prior), no psych evals or visits to the nutritionist. Made the whole process tons easier.

[crusin2wardsloosin 0]

Thanks so much for the good news!!! Im so excited !!!!!!! Had psych eval today it went really well he cleared me for surgery.I had to pay $250,he said I could submit it to the insurance company to see if they will reimburse me. My next step is the nutristionist and nurse on the 12th of May,that will cost $325,they said the insurance dosen't cover it.Then there is one more appointment and thats with surgeon to go over things and get a surgery date!!! They don't contact the insurance company for approval until after you meet with the surgeon. I would think approval first then date,but that is the way they do it. Thanks again.

[Sgt Bob 1]

Thanks so much for the good news!!! Im so excited !!!!!!! Had psych eval today it went really well he cleared me for surgery.I had to pay $250,he said I could submit it to the insurance company to see if they will reimburse me. My next step is the nutristionist and nurse on the 12th of May,that will cost $325,they said the insurance dosen't cover it.Then there is one more appointment and thats with surgeon to go over things and get a surgery date!!! They don't contact the insurance company for approval until after you meet with the surgeon. I would think approval first then date,but that is the way they do it. Thanks again.

Tricare covered all of my pre-op appointments. If your doctors are making you pay, that is probably their choice not to accept what Tricare will pay, not because of Tricare.

You can file the claims yourself and they will probably pay you, but not the full amount.:tt1:

[Cadets71 1]

I had to pay $225 to the nutritionist; it doesn't look like Tricare will pay for that. Has anyone had success putting in a claim for the nutrition consult?

Mary