Tricare Prime Approved!!...But Outpatient Surgery??

[Mommie_of_4 0]

Well Tricare Prime (South) approved my surgery!! :biggrin: So I'm excited about that!! But from what I have read and discussed, Tricare has required an overnight stay and the surgery had to be performed by someone from the Center of Excellence. On my tricare authorization letter, it says 'General Surgery, Outpatient'. Has anyone else been approved and didn't have to stay overnight?

I'm almost scared to call Tricare because I don't want them to say...oops we made a mistake and you are not approved!! I have more than 2 comorbids but little less than 100 pounds overweight.

Also, Tricare hasn't said that I needed to have all of the pre-tests done (ekg, etc...) that a lot of you have had. I've only done the nutrition and physch (7/15). Doctor has never mentioned the other tests.

Any answers would be appreciated!

[LISAMARIE1158 0]

In Mass its always booked as an out patient, unless you have your surgery after 12 noon. From what l have heard people feel a whole lot better going home to their own bed....good luck....

[Jessica Wren 0]

I was also approved for out patient with my insurance but was told at the hospital you can stay overnight as long as you are there less then 24 hours. Personally i was there a little longer then that but was told it was ok. At first I was upset that I had to stay over night (my dr was just starting with the band and just wanted to make sure everything was going to be ok) but in the end I'm glad I did. I was really nausea so being in the hospital relaxing and being able to take their meds really helped me. I know a lot of people don't have to stay overnight and are happy to do that. I guess it just all depends on the person! Good luck with your surgery and congrats for the approval!!

[To be free 1]

Did you look online at the Tricare website to see if it said the same? Mine on line only showed for the Surgeon and it said inplant adjustable device and the surgeons name or somehthing like that, there never was one for the Hospital that stated inpatient or out. Now I am in Florida maybe it is different.

I would have the insurance professional at the surgeons office contact them and they will know if it is outpatient or in.....thats who told me mine was inpatient.

It could be that they are finding it more cost effective to do it outpatient.....they are cheap, they only paid my surgeon $935.00 for the surgery but paid the hospital over $16,000. I would think they would pay the surgeons more.........

Don't get me wrong I have never had a problem with Tricare and are greatful to have them I just think he should have been paid more.

[kandyss 0]

Im tricare just got my surg. on the 3rd. They dont tell you , you need all the work up done. You have to go through your pcm and have them order it.

[JenniLeen 0]

hoooray for approval! I can't help with the inpatient/out thing but I didn't have to do any of the pre-tests either. I had to have some blood drawn and that was it. Don't be afraid to call Tricare!! I can understand what you mean, but call them or the surgeon if you're worried.

[thatDEgirl 1]

All Tricare required for me was nut/pysch eval. My surgeon requires bloodwork and an EKG which is covered by Tricare.

I don't know about the in/out patient thing, my surgeon requires an overnight stay.

[dial135 0]

I'm also approved with Tricare Prime (South)...Dr. Lord at Sacred Heart in Pensacola. The office is well versed in dealing with insurance companies and I'd have them call to confirm the issue with outpatient vs inpatient. When I first started looking into the lap-band, April '07, Tricare only approved the by-pass. So it was a blessing in January this year for Tricare Prime to finally see the light.

Best Wishes! My surgery date is Aug 5th.

David

[asimmons 1]

Hi, I am new to the forums but had my surgery on 6/10/08 through Tricare. I got my approval in a little over a week. However, it was for Outpatient and my dr wanted me to stay overnight because of severe sleep apnea. The insurance person at the center called Tricare and had them change it to overnight - no problems at all. As for all of the tests, it was the dr who required them and not Tricare. However Tricare covered them with no problem. I am also in Florida And I have to say Tricare has been great to deal with.

Anne

[Ineedalapband 0]

Can I ask how long it took from submission to approval? My paperwork hasn't be submitted to Tricare South yet but I want to know what to expect as far as time when it does.

I agree with previous posters that said its the surgeon that requires certain tests, etc. not Tricare. All I had to do was the psych eval and some blood tests. I'll have to get an approval for surgery after approval and thats it. Tricare only requires me to meet the 100lb/comorbid requirement.

Call the insurance person at your Dr. office and ask about the overnight stay or just call Tricare and ask them. Just tell them your confused and could they please tell you if you are required to stay overnight or not.

Good luck and keep us posted. Congratulations on your approval! :biggrin:

[IntoLess 0]

From submittal to approval, mine took less than an hour, maybe 45 minutes.

I was approved for an overnight stay, but that is precautionary for my doctor, he wants approval for overnight in case it is needed. When I received my approval and it was for overnight, I called my doctor's office, and they told me it is done as outpatient, and they request inpatient for everyone, regardless of insurance.

A friend just had hers done through Tricare, and she was outpatient.

Don't fret about it, you have the paperwork, typo or not, they have approved it. Just remember to ask for a copy of the approval.

[dianah_m 0]

so im reading this right your weight was 100 lbs over..the lady at the dr told me i have to be 100 lbs over weight, she said i need to gain 28 lbs that would give me an bmi of 41.1, but i told her i had diabetis and high cholestrol.. so i told her i still wainted an appointment hopefully tricare will approve im being seen in austin

[Mommie_of_4 0]

so im reading this right your weight was 100 lbs over..the lady at the dr told me i have to be 100 lbs over weight, she said i need to gain 28 lbs that would give me an bmi of 41.1, but i told her i had diabetis and high cholestrol.. so i told her i still wainted an appointment hopefully tricare will approve im being seen in austin

Not sure if I was over by 100 lbs or not...my bmi was less than 40. My dr. submitted my paperwork to tricare and it was approved. Do you have a consult approved with the dr. from tricare already? if so, schedule the initial consult and have them submit the insurance paperwork. If you have to tell them that you would self-pay if insurance denied surgery then do it. Thier initial visit with you is covered already..

[dianah_m 0]

yes my consult was already approved. i have an appointment next week. the Patient Advocate said she didnt believe that they would cover me because my bmi wasnt 40 and i wasnt 100 lbs overweight i need 20 lbs to go. but i told her to still book the appointment its worht a shot since i have some comorbids high cholestrol, triglycerides, diabeties

[Insky67 2]

I am tricare prime south. I had no trouble getting approved and when the ball started rolling it actually went very quickly.

My surgeon told me to get the pysch eval and told me what docs she would accept it from, I called tricare told them and they gave me the referral. I had my EKG, Blood work, Chest Xray all done by my PCM's office.

I did not need to see a nutrionalist. I also had an over night stay. If you want to talk to me about it more you can email me at RobinNGabster@aol.com.

I'm 40 days post-op now and down 42 pounds. Good luck with your surgery and please feel free to email me any questions.

Robin