Tricare and PCM

[Stoiic 0]

I do not believe that I am borderline, I am 5'6 312lbs with a bmi of 50.2 . I also have high blood pressure, edema and arthritis in my back and knees.

[Jesusislove 26]

Hi, I don't think you are border line either, you may fit the 200% qualification, which is automatically approved. I would get a little more stern with the docs, speak up a little stronger. I would tell them that I know you do not think I should have this done but I need this done, I need to do this for myself. I am asking you as my doctor to help me get healthier because I have tried everything at this point.

[1000words 0]

I agree. I think you either need to see your PCM again or take the steps to file a grievance.

Tell you doctor that you want the referral then you will rely on the surgeon and his staff to evaluate you for the surgery. If they think it is a bad idea, then they will not do the surgery.

Just be polite and firm about the fact that it is your decision. Let the doctor know that without his referral you will be forced to switch to Tricare Standard and pay more out of pocket. (since you would not longer need a referral) If he still refuses, see if there is a tricare service center or consult center at you base and ask to speak to someone there.

Good luck,

Kris

[Stoiic 0]

So I went to see a third doctor today who I finally got to give me a referral for consultation with the surgeon. Now she said it would take 3 weeks before tricare got back to me regarding the referral and who I could go see. Is this normal and what exactly am I waiting for a letter? Or do I contact someone else now to make the appointment?

[SilentBob 0]

3 weeks is the standard time period for the referral to process, it will probably be 7 days or less though. You can check referral status online as well I believe. It will probably be three weeks before the letter gets to you but if you call your Tricare office sometimes they can get the referral approval #s and give them to you in case you want to speed things up.

[Jesusislove 26]

Hi, it should be sooner than that, most referrals usually take 24-48 hours, my consultation referral took a couple of hours, my actual surgery approval took 2 1/2 days. They probably can take up to 3 weeks, but I have never seen it take that long. You can check you referral online, create a user name and password. It will show you the entered referral as well as whether it is approved or pending. Have you chosen a surgeon you would like to see?

Edited April 29, 2008 by LLPlady3

[1000words 0]

Congratulations on getting the referral! The referral process works a little different at each base.

At one at my bases, the doctor put the referral in while I was in the office and it went through directly to Tricare(showed up within 2 days at Tricare). At my last base the doctor put the referral in and it went to the consult center at the local military hospital and if they didn't have an appointment or a doctor of that specialty it then went through to Tricare (showed up within a week). At this base the doctor told the nurse to do the referral and it went to another department at the clinic they referred the referral and then sent it to Tricare(took a week to make it through the clinic to Tricare).

So, just be patient, but if it doesn't show up with Tricare in the next 5 business days I would call the clinic to make sure the referral went through.

Congratulations again!

[Stoiic 0]

what website do i use to check to see if the referral has gone through? I make my appointments on tricareonline. but i do not see that option anywhere. Thanks for all of the help.

Oh and my doctor filled out the consult form on the computer in front of me and said it was processed and then she gave me a copy of it with her signature and things on it. so not really sure which of the 3 ways it was :-)

[Stay_Tuned 0]

Once you log into the Tricare website you will see on the left hand side something that says ref/auth. click on that and then click the bullet for 0-2 weeks... and PRESTO you should see your referral!!!! Then you can print it off and use that.... It should only take about 24 hours for that to show up... You will also get a paper letter from them with the same information that should take 7 days.

Hope this helps! and congrats on getting the referral!! I am super psyched for you!!!