Tricare Prime - Got The Referral, Now What?

[Fdiljn 0]

Stay Tuned I know this is not the thread you would normally post this information but how about giving us a little update on your recovery (what was it like) and how you are doing.

[Stay_Tuned 0]

I am doing really great... Better then I had expected actually. I had my gallbladder out Oct 07 and that was WAY worse then the recovery from lapband.

I go for my two week post op appt today and I hope to get the ok to start back at Curves. I have missed going there and I need to get back on track with that as well.

I have been doing liquids and I am very satisfied. I never feel hungry unless I have waited too long for a shake. In fact waiting on people to eat is a pain in the rear LOL!

I am guessing that since I went to my PCP for my referral to the surgeon I have lost almost 25 pounds. Since my surgery I have lost about 12. I came home from the hospital 10 pounds heavier then when I left the morning of my surgery. So really I have lost almost 20 since I came home. It took almost a week to get the 10 pounds of swelling and fluids out of me.

Let see... I can sleep in any position that I desire with no pain. I can sit up from laying down flat no problem. My incisions are all about healed except for the port one. One end of it is still a little red but I am treating it. I have a little bruising left behind but other then that all looks good with the incisions... I actually have to hunt for one of them.

I should be able to start full liquids after my appt today... so some cream Soups and yogurt cottage cheese things like that.

If you have any other questions let me know.... I am pretty much an open book!!

[bama_belle 0]

Congratulations, and hang on - if yours goes anything like mine, it will be super fast! I sort of did things backwards. I got a referral to a surgeon, got an appt. with them, then realized that I needed the PCM referral, got that, saw the surgeon on 4-7-08, was approved on 4-14-08 and was scheduled for 5-29-08. They actually wanted to schedule me for 5-22-08, but I wasn't available that week.

CONGRATULATIONS!

[mphsmommy 0]

Thanks. I was able to go to the clinic with my Tricare PCM change paperwork and make an appointment. The first available one they had was June 24 though :confused:. I'm hoping if I call everyday, they will have some cancellations.

[Keleka 0]

Hi! I have TriCare Prime Remote and I just went to the information seminar this evening. They did height and weight measurements and made copies of my drivers license and insurance card. They said they will call Tricare and find out exactly what I will be responsible for and let me know in about a week. I don't have an in network physician near me that participates with bariatric surgery so I am hoping Tricare will cover this physician at an in network cost.

[bama_belle 0]

Thanks. I was able to go to the clinic with my Tricare PCM change paperwork and make an appointment. The first available one they had was June 24 though . I'm hoping if I call everyday, they will have some cancellations.

OK. Here's what I would do while waiting. Start doing your research of all of the doctors in your local area that do the surgery. See what info you can find, how their patients feel about them, etc. and go ahead and decide what physician you'd like to use. If you call Tricare, they will give you a list of "covered" physicians in your area and you can work from there.

Once you've narrowed it down, contact that surgeon and find out what he or she requires as far as paperwork, etc., and if possible, get them to go ahead and send it to you (mine has all of his stuff online, so that was great!) and that will cut down on some of the wait time. Get that paperwork filled out and go ahead and get that sent in to the surgeon.

Then, once they get the referral from the PCM, you'll already be a little ahead of the game!

And great idea about calling regularly to see about cancellations. :thumbup:

[mphsmommy 0]

No cancellations so far. :tongue2: I called Tricare today and they couldn't really tell me anything I didn't already know. I called the Bariactric center here on base (Fort Bragg) and they said I can go to a seminar and support group meeting before my appointment, so that makes me feel better, at least I won't feel like I'm not doing anything. :thumbup:

[eazes 0]

Can you call the clinic and leave a message for your PCM? I left numerous and I mean numerous messages for my PCM to put in my referral. I was also able to attend a seminar before my referral was approved. Luckily my doc got my message and my referral was approved before the seminar . Also call the bariatric clinic and see if there is any paperwork you can get from them early to fill out. I've called the bariatric clinic here so many times the coordinator knows me personally. LOL

[mphsmommy 0]

I can go to the seminar without a referral. I'm sure my PCM won't give me a referral without seeing me first cause I have never been to the doc here, I just changed my Tricare over this week. I'm going to a seminar this coming week.

[Ineedalapband 0]

I went to my PCM on Tuesday and I still can't see my referral online. How long should it take? Everyone else seems to have gotten theirs quickly. Can Tricare not give me the referral even if my Dr. put me in for it?

I signed up for a seminar but decided not to go since I found out from another poster that its not required by the surgeons office. Its a far drive for me and I'd need a babysitter. So I prefer to skip it. I already know Ineedalapband. :biggrin2:

[eazes 0]

I went to my PCM on Tuesday and I still can't see my referral online. How long should it take? Everyone else seems to have gotten theirs quickly. Can Tricare not give me the referral even if my Dr. put me in for it?

I signed up for a seminar but decided not to go since I found out from another poster that its not required by the surgeons office. Its a far drive for me and I'd need a babysitter. So I prefer to skip it. I already know Ineedalapband. :biggrin2:

It may still be in your best interest to attend a session. They may provide paperwork there that can speed the process. Also it gives you a little time to meet with the doc and meet others that are going through the same thing. I thought the same about attending a support group here. I thought why should I go. I already know I want to do this, I need to do this. Once the session was over I was glad I attended. The stories from the ladies that had various WLS were awe inspiring.

Also check with your PCM to make sure everything went through ok. For me it turns out that my PCM put it in for the wrong office. He thought I had to see General Surgery at the naval hospital here when I just needed to see the doc out in town. Stay on them. Get a direct line know his nurse by his/her first name. CALL CALL CALL!! :smile: Eventually they will get so sick of your calls they will make sure everything goes through for you to be approved. :scared2: At least that approach has never let me down. :tongue2:

[Ineedalapband 0]

I just checked and I can finally see the referral now! It was for a Dr. I've never heard of though so I called and asked Tricare to change it to Dr. Redmann. Now they tell me I have to call his office and make sure he's accepting new patients before they can do that. I called and of course, no answer. Let the run around begin...:biggrin2:

[Fdiljn 0]

I just checked and I can finally see the referral now! It was for a Dr. I've never heard of though so I called and asked Tricare to change it to Dr. Redmann. Now they tell me I have to call his office and make sure he's accepting new patients before they can do that. I called and of course, no answer. Let the run around begin...:biggrin2:

Please do not get discouraged this early in the game. Keep the faith and know that everything that happens -- happens for a reason. Know that a power bigger than us is really in control. Dr Redmann's office has always returned my calls within one business day so if you left a message today you will hear from them tomorrow. Positive thoughts to ya!!

[IntoLess 0]

I had the same problem with my psych eval, kind of. I was referred to one psychologist who couldn't see me, so I called to get a list of others. They gave me the list, and I called each of them, but they were all CHILD PSYCHOLOGISTS!!! I called back, told them the problem and the sent me to MENTAL HEALTH! I explained the situation and they transferred me back to the original customer service agent. I spoke with her for a few minutes, telling her who I got to replace the original doctor, and again she transferred me to mental health. Right now my referrals and authorizations page has 3 referrals to the same doctor, all for different reasons! I finally gave up that day, called back last week, told the girl my story and she kind of chuckled, and then took care of everything. I thought I was going to need mental health before it was all over with!

That was an awfully long story to get to my point..........it all worked out for the best, and I passed my psych eval this afternoon. He said there was no reason I shouldn't be a perfect candidate for the band. I am so excited, his approval was all I was waiting for to get the doctor's office to turn it over to TriCare for approval.

[Ineedalapband 0]

Thanks guys. Actually I did get a call back pretty quickly and they of course, are accepting new patients. I called Tricare back and they fixed my referral right then. I tried to make an appt based on that but Dr. Redmann's office said I couldn't make the appt without them receiving the fax of the referral. So now I'm just waiting for Tricare to send that to them or for me to get the referral in the mail so I can fax it over.

How long did it take you guys to get the letter so you could make the appt?

Kitty, are you worried? I mean, I'm so worried I'm going to go through all of this and then have Tricare disapprove me. Are you going to Dr. Redmann too?