Tricare and PCM

[Stoiic 0]

I have tricare and I do meet the requirements for the procedure my only problem is I can't get my doctor to refer me, he is in the mindset that surgery isn't an option and that diet and exercise will fix everything, even after being on several diet and nutrition programs and countless gyms. I don't know if I should ask for a new PCM who understands where I am coming from or what. I am so lost as to what to do now.

[frenchvanilla 0]

I had the same thing happen to me with several different doctors,I just kept changing doctors till I finally found one who agrees that I need weight losss surgery,and thank God I finally found one! i had so many tell me to just diet & excerise, I know what your goin through

[irideaqh 0]

You could tell your current doctor that you have tried other options, done your research and believe that LB is right for you and that if he will not refer you that you will change to a different PCM. Maybe he will take you more seriously and put in the referral.

You could also let him know that you need the referral to meet with the surgeon to discuss the procedure and figure out if it is really an option for you. Your PCM doesn't refer you for the actual surgery, he just refers you to the bariatric surgeon, who then puts in the referral for the surgery.

If you want LB, I would definately push the issue and do whatever you need to in order to get a referral.

Good luck!

[StephieNana 0]

My dad's doctor told him the same thing, but when he finally came out and told the doctor that he would just find one that would refer him, the doctor came around and made the recommendation. My dad and his doctor are both THRILLED that he had the surgery now. He lost 140 lbs with lap band in 1 year. He is in the best shape he has ever been in. Now, I'm just hoping to follow in his footsteps! :thumbup:

[Cadets71 1]

Stoiic,

I am assuming you are Tricare Prime? If so, get a list of Prime providers and go to a lap band seminar. At both seminars I attended, the Doctors said they could give you the names of PCMs that are supportive of the surgery. Ask them to look at your list and see if there is anyone they can recommend. If you are Tircare Standard - no problem; it is easy to change PCMs.

Good luck,

Mary

[Pix 4]

I have tricare and I do meet the requirements for the procedure my only problem is I can't get my doctor to refer me, he is in the mindset that surgery isn't an option and that diet and exercise will fix everything, even after being on several diet and nutrition programs and countless gyms. I don't know if I should ask for a new PCM who understands where I am coming from or what. I am so lost as to what to do now.

I feel your pain, my old PCM thought he was the specialist for everything :thumbup: Needless to say when I switched PCMs my new one is great. He referred me right over and has been one of my biggest supporters. If all else fails call and make an appt with another doc out of your team, or another doc on your team. Keep doing that until you get one who will refer you out.

[Jesusislove 26]

Hi, is your doctor at a military treatment facility or off post? If he is on post, they will try to keep you from going to an outside doctor. If he is off post discuss it with him one more time and if not; go on your Tricare website and put in your zip code and it will pull all doctors in your area that are participating providers. Once you do this, click on the doctor to see if he is accepting new patients. You will look for a family practice doctors, usually those are PCM's. Your local Tricare office should have books also that give you a list of doctors in your area. I would switch doctors if he keeps refusing to refer you. My doctor is the sweetest doctor in Georgia to me, he knew what I had already done and he stands behind me 100%. That is the kind of doctor I would look for. You can actually change PCMs online, very easy.

Edited April 17, 2008 by LLPlady3

[Stoiic 0]

Hi, is your doctor at a military treatment facility or off post? If he is on post, they will try to keep you from going to an outside doctor. If he is off post discuss it with him one more time and if not; go on your Tricare website and put in your zip code and it will pull all doctors in your area that are participating providers. Once you do this, click on the doctor to see if he is accepting new patients. You will look for a family practice doctors, usually those are PCM's. Your local Tricare office should have books also that give you a list of doctors in your area. I would switch doctors if he keeps refusing to refer you. My doctor is the sweetest doctor in Georgia to me, he knew what I had already done and he stands behind me 100%. That is the kind of doctor I would look for. You can actually change PCMs online, very easy.

He is at the MTF, I guess I will try and change PCM's only thing with that is it seems to take almost 2 months lately to get an appointment if your PCM is busy and they will only let me see another one for prescription refills.

[Jesusislove 26]

Hi, you can change PCM online and from what I was told by Tricare, as long as you have put in the change you can start seeing the new PCM. You will have to call them to see if they are accepting new patients first, and then they (new PCM) will have to call them. It seems faster when you do it online.

[Stoiic 0]

I went and saw a different doctor and she would only go off what the other doctor suggested. So now I am stuck again, not sure where to go from here.

[1000words 0]

I am so sorry to hear about your problems. My PCM was very understanding and supported by decision. If she wasn't I was going to go directly to the tricare office and put in the request for an off base PCM.

What is your height and weight stats? Are you borderline for qualifying? What base are you at? I hate that a personal bias is going to keep you from looking into it.

One option for you would be to change from Prime to Standard. You would have to pay a portion of the surgery out of pocket... but it might be worth it. (just make sure you choose a doctor that is covered by Tricare)

[aculberg 0]

I had the same thing happen to me, were stationed at Hill AFB in Utah, and I went in and spoke to my PCM and she was all about exercising everyday, etc etc, even though I've tried almost everything! I think I am on the borderline of not being approved b/c I'm not "heavy" enough! To me, I am!! So, my question is, does anyone know of a good PCM, on or off base here in UT that would approve it? Or can I go to the lapband doc and they can approve it?? Does anyone know what the requirements are? I am 5'5" and weigh 229 with a 38 bmi. I have hypothyroidism, and lately elevated blood pressure. I have been going to a medical weight loss clinic for over a year now, and paying out of pocket, which gets way expensive. I was down to 206 going there, but then life takes over and here I am! Any info and suggestions would be great!!

[minpinmom 2]

aculberg ~ Off subject, but we were stationed at Hill! I loved it. We had Dr. Bluth (he was okay, but not sure of his view on weight). I worked for the ICBM SPO, I did computer support.

Hope the weather is friendly - I loved this time of year there.

[aculberg 0]

minpinmom ~ We love it here too, but weve been here forever (8yrs) and were ready for a change! Where are you at now? How did you get your pcm to approve the surgery?? So many questions....:rolleyes2:

[minpinmom 2]

We left Hill in the beginning of 2004. So we were there for a while with you! Small world. My husband was medically retired so I dealt with a civilian Dr. for my referral. We moved back "home" which is Texas. We are just North of Houston.