Another tricare approved

[eazes 0]

I'm still waiting on my approval but since I told the surgeon's nurse that my PCM submitted my referral she went ahead a processed my information. I get my Pre-Surgery packet from her on Thursday. Hopefully I'll have the green light from TriCare by then.

[Keleka 0]

Ok... so I've been waiting since last Monday to see what surgeon TriCare is going to send me to. It turns out after I called my PCP they (TriCare) faxed them a general surgeon whose specialty is vascular! So I called TriCare and she told me if I could find a Surgeon who accepts TriCare that does lap banding to have my PCP fax the info to them. It turns out the surgeon that did my sisters Gastric Bypass is now doing banding. I already have my appointment to go the informational session. I just hope TriCare covers this at 100% I feel this may be a long road of making sure every T is crossed and I dotted! I would be interested to see others trials in getting approvals!

[aculberg 0]

Hi there, I too am trying to get approved through Tricare for the lapband. I had to change my pcm from on base to off base b/c the doc on base was completely uncooperative! I have gone to the lapband seminar and they say you do have to have a referral from your pcm to get started. So, thats where I'm at, waiting for Tricare to update my pcm so I can go and see him and get the referral. I am kinda nervous about getting approved because I am probably just below (within 10 lbs) of being 100 lbs over. I do have hypothyroidism (slow thyroid) and some knee joint issues and I heard from the surgeons nurse that if you have urinary incontinence, thats also a condition?! So, sounds like were all in the beginning stages of getting approval, nice to know I'm not alone!! Good luck and lets keep each other posted!

[katinafer 0]

I'm new to the boards and was wondering if there is anyone out there who had or is having there lap bad done in the Columbia SC area? I received the referral from my PCM on May 13th which was authorized for 4 visits with Dr. Tribble at Palmetto Regional and attended the seminar May 19th. They couldn't get me in for my next appointment until June 23rd. Any experiences with Tricare Prime in the south as far as nutritionist/psych requirements etc. I'm hoping it will all go through. I'm 5'3" with a BMI of 40...also recently had to have my gallbladder removed laproscopically and have a strong family history of severe hypertension and diabetes. Any input would be greatly appreciated.

[Keleka 0]

Hi aculberg & katinafer!

I'm still waiting to get the referral to go to a surgeon. It says on the tricare site to wait about 72 hours before checking, but I don't think they post very quick on their referral and auth page! The funny thing is the Dr they originally had me going to was a vascual surgeon:huh2: When I got home this evening there was a message for me to call their office (they probably want to know why tricare is sending someone there for lap banding:confused2:)lol

So anywho, I am really hoping the Surgeon I would like to go get authorized! Once I am able to go I don't think I will have any prob meeting the requirements (5'3" approx 275 and high blood pressure) I know with TriCare you really have to keep on top of things! And not give up!

I'm TPR north region and I'm not sure as to what the else they require as far as nut, psych etc consult. So any info you get please pass on as I will also!

It's nice to know and meet others going through this! Let's keep each other informed!:biggrin2:

Thanks and good luck to both of you!!!!

[1000words 0]

The only thing I had to pay for was the nutritionist... which was a waste of $156, but it was part of the process.

For the psychologist I went through Tricare Value Options and the appointment didn't cost me anything since I went with a Tricare provider. I did not need a referral for the psychologist, I was able to self refer. The obesity center was able to recommend a band-friendly psychologist that was on my list.

It looks like my surgery is going to be on June 9. Hopefully everything is smooth sailing until then.

[Keleka 0]

Hi All!

So I called TriCare this morning and was told I was approved for the first visit to the surgeon!! YEAH! I called the surgeons office to make the apt and she said that before they can schedule an apt I would need to go to the informational meeting. I told her I was already scheduled for that and I told her I already had my referral # for the first visit. She laughed and said I was ahead of the game! I hope things continue to go well! Will keep posting updates!:tongue:

[katinafer 0]

My first Dr. appt is not until June 23rd so I tried to be proactive and go ahead and schedule the psych eval & nutrionist appts. The Dr. office told me that I had to come to the first appt with them first and they would schedule my psych & nutritionist appts. I called Tricare this evening with a few questions and the rep said the they do not require the psych eval or nutritionist appts. Has anyone been able to skip these two appts? Just curious. Thanks

[1000words 0]

Well... even though Tricare doesn't require it... a lot of doctors do require the pscy and nutritionist consult. The thing with the psych consult is the only way Tricare will pay is if it is to treat something other than weight loss... for instance I had to go for depression.

Good Luck

[gina s. 0]

Tricare paid for my psych eval and I didn't go for any other reason.....they did the evaluation one day, and then I went back for the results and that was it. I was able to self refer also. And I did not have to see a nutritionist.....I saw a dietician at the hospital where I'm having the surgery. It was part of my consult with the surgeon. I haven't had to pay anything out of pocket and according to the financial advocate at the hospital, all I'll have to pay is $25 for the hospital stay. I won't have a co-pay for fills either. So this whole thing is going to cost $25.

Edited May 22, 2008 by gina s.

[Keleka 0]

Hi Gina! Thanks for the post. I have a question.. are you TriCare Prime Remote? And was your Doctor in-network? The one I am going to isn't in network... but then there isn't another surgeon in my area so I am hoping mine is covered at 100% I was approved though for one visit.

[minpinmom 2]

Sorry, this question was a few posts back, but Tricare goes off of the HIGH weight end. So, if you (like me) are 5'4", according to the Metlife Charts, I should weigh 114 - 127 for a SMALL framed female. (I am actually medium framed, but the Surgeon put small frame (thank you Dr.!)

I weighed 259 lbs. So I got in on the 200% over ideal weight. 127lbs X 200% = 254lbs. I barely made it!

Tricare didn't require anything but a letter of medical necessity from the surgeon. I was approved within 24 hours. Once the Dr.s office got the approval, I had surgery 6 days later.

[gina s. 0]

Hi Gina! Thanks for the post. I have a question.. are you TriCare Prime Remote? And was your Doctor in-network? The one I am going to isn't in network... but then there isn't another surgeon in my area so I am hoping mine is covered at 100% I was approved though for one visit.

No, I'm just Tricare Prime South.....I'm at Ft. Hood. I had three choices of where to go for the surgery since they don't do it on post....I could go to the post in San Antonio, to Southwest in Austin, or to Scott and White in Temple. I choose Scott and White since it's only 30 miles from me. I think the surgeon is not in-network. The financial counselor there told me all I would have to pay them is the $25 fee for the hospital stay....which is the same amount I had to pay to have my daughter almost five years ago! Except I don't have to stay overnight this time! If Tricare approves you and you have Prime, it should be covered the same as mine. Oh, and she also told me fills are covered 100% too.

[Keleka 0]

Thanks Gina:smile2:!

Not know what to expect is half the battle! That's why this site is great! We can all share our experiences! Sounds like once the ball gets rolling it won't be too bad. Keep posting on your progress and Good Luck!!!!

[minpinmom 2]

Gina,

My surgery was supposed to be outpatient as well, but Tricare requires you to stay overnight or they won't pay. So I ended up having to stay overnight. Make sure you double check! (I was one of the fist to go through the process once it was an approved procedure, so things may have changed, but it hit me as a surprise)