Tricare

[JamieNP 20]

Yeah!!! Hopefully I am next to find out. Everything should be submitted to Tricare this week or next.

[Nena 0]

I have tricare prime remote south. I went to the seminar at the beginning of July and my surgery is scheduled for Aug 25. Psych eval? I didn't know I had to have that. My dr told me that it's going to be outpatient.

[KarinaM 0]

Hi, I had all my stuff together(PCM letter, Psy eval, nutricionist eval,blood test, sleep study and surgeons letter) and the surgeon coordinator at m Dr's office sent everything to Tricare on friday, on monday I called and they told me they needed a refferal form from the Dr's office to be filled out. I called the surgeon coordinator and she told me she would send it. On monday I called and they told me they got the fax and it was pending.Next day I could see online on pending.

Called again on wed and they are telling me they need more clinical info from the Dr, called the surgeon coordinator and she told me she had no time to send anything but she would contact Tricare when she had time, so I'm not waiting on Tricare, but on the Dr's office.

I hope I get approved.I wonder if the fact they need more info is a good thing or not....

[Maggies 0]

karin, hopefully it is good that they are asking for more info. There are so many hoops to jump thru to get this surgery but it will be all worth it when we are on the losing side. I have spent the last two weeks trying to get my mental health evaluation from the base hospital so I should have everything I need next Thursday. Good luck to you and hope you get good news real soon. Maggie:thumbup:

[KarinaM 0]

Maggie, I called Tricare AGAIN this morning and they told me she had no faxed the remainder information to Tricare yet. I called her and I was on hold for over 10min and they told me they would give her my message. I'm seriously thinking on going there and talking to her in person. Is this too much???????

[Maggies 0]

I think talking to her face to face would help. It seems she would know how much this means to you and it only takes a minute to fax the info to Tricare. If you are face to face with you it will harder for her to make excuses why she can't do it, and if she does, offer to take it to Kinkos or somewhere yourself to fax it. Hope you get good news today. Maggie:confused2:

[KarinaM 0]

I'm having the same problem now. I have ALL my stuff ready and it was faxed on friday to Tricare (It could be done on thursday but the surgeon coord did not fax it), on monday I called and they told me they needed some referral form filled out. Yesterday, I called again because was still pending and I was told they need some "clinical info" from the Dr's office, I keep calling the surgeon coord and when I finnaly got hold of her yesterday she telled me she was too busy and had no time to talk to the Tricare nurse. I called today all day and she still have not send the info to Tricare. Apparently the nurse at Tricare wants to know if I am taking medication ofr Diabetes and other info and I'm depending on this lady. Wait is killing me.

I have read that most people get a quick response. So, I was definitely disappointed when I didn't get one. To be honest, I think the problem was not with Tricare but the nurse reviewing the docs and making the decision.

Overall, it seems that Tricare is one of the fastest companies to give approval. Anyway, none of that matters now. I've gotten my approval and only have 11 more days until surgery. :biggrin:

[KarinaM 0]

I called at the end of today and still nothing. I had decided to be there tomorrow at 9am but my husband thinks I will getting her pissed off at me and this will not help me at all. He told me to wait, like it is easy

I think talking to her face to face would help. It seems she would know how much this means to you and it only takes a minute to fax the info to Tricare. If you are face to face with you it will harder for her to make excuses why she can't do it, and if she does, offer to take it to Kinkos or somewhere yourself to fax it. Hope you get good news today. Maggie:confused2:

[Maggies 0]

Waiting is not easy, but maybe he has a point. Thursday is my day with the surgeon, then everything should be sent to Tricare for approval. This is so stressful. Let me know when you hear something. Maggie:thumbup:

[AshleyBlue 0]

I have tricare prime. I understand I need a referral ( which is starting to feel impossible ) I keep getting different information. What are the requirements for Tricare I am 100lbs overweight but I don't have any documented co morbidities. I had to have my gallbladder removed four years ago and I have back pain but I haven't had any bloodwork done since I moved here three years ago. I was told the 100lbs was enough by the surgeons office but the nurse at the base is telling me she won't do a referral without two co morbidities. Can someone please make sense for me. I am really up and down emotionally with this I get excited thinking its going to go through and then so angry when I hit a wall. Anyone with advise Please Help.

Thanks

[KarinaM 0]

Ashley, you will need to work the "system" a little. I went to my PCM and cryed and told her how miserable I was and how much I needed the surgery. I'm not 100lb over but before my blood work, I had some chocollate and my blood sugar went up, after that, I put on a little more pounds and after getting the approval for the surgeon, my PCM also helped me to get a sleep study. I had my PSY eval (tricare will give you 9 seccions with a PSY, just don't tell Tricare is for WLS eval, just do it as a consultation, you will have to let the PSY Dr. know, of course you need a eval for WLS. I also "got shorter" 2" hehehehe, making my BMI higher. I'm not sure if it will work, but since they never want to pay for anything, I think we need to do our part sometimes.

Hope this help you and DO NOT GIVE UP.

[KarinaM 0]

Waiting is not easy, but maybe he has a point. Thursday is my day with the surgeon, then everything should be sent to Tricare for approval. This is so stressful. Let me know when you hear something. Maggie:thumbup:

Hi, I called Tricare and they told me the surgery coodenator had called tricare and she asked to talk to the nurce in charge, but at least she called. Maybe by monday I will know something. I guess will be a LONG weekend.

[Maggies 0]

Karin, Stay busy over the weekend to try to keep your mind off of everything. Easier said than done, I know. Hope Monday brings good news for you. Have a good weekend Maggie:cool2:

[KarinaM 0]

Karin, Stay busy over the weekend to try to keep your mind off of everything. Easier said than done, I know. Hope Monday brings good news for you. Have a good weekend Maggie:cool2:

I will try. When I called the Surgery Coord told me she had send to Tricare everything they needed and when I called Tricare they told me they still needed more clinic info and that the Dr's office had requested a call. I gues this will take way longer then I was expecting. Thanks for all the support.

[Roustabout 0]

I'm retired military and live a long way from a military base. Instead of paying $400 plus per year for Tricare Prime then having to have a primary care physian referral for every thing, I pay nothing and have Tricare Standard. With Standard there is no referral requirement. I just make an appointment with the Doctor I want to see and proceed.

Tricare's requirements for lapband is published as 100 #s over your weight and one co morbidity. Less requires two co-morbidities. No morbidity requires 200 over. As you in Tricare know, at most they just read and react.

I had a nearly two:blink: months snafu because the doctors office didn't send the paperwork forward for nearly three weeks after I saw him and then sent to the wrong place. After lots of time on the phone, I located the correct Tricare office, to find they had never heard of my desires for the surgery.

I got a correct fax number and called the doctor's office again. They faxed it on Friday, it was approved the following Tuesday and six days later I had the surgery.