Tricare approved quickly- now what?

[tomatogirl 0]

I went and saw my PCM a couple of weeks ago for my yearly pap and asked her about banding. She said she would research the requirements and if I was really interested, she would put my referral in. She called back later in the week and said that I fit the criteria, so she would put my referral in. She put it in for Bethesda and it got kicked back because Bethesda doesn't do WLS, so she put it in for Walter Reed. I went out of town for 3 days, got back today and had my referal letter in the mail for a civilian doctor in town, which is fine. :tt2: But, um, what now? :confused2: Do I just call up and say, "Hi Dr so-and-so, I go referred to you by my insurance company for gastric banding" or what? What about the psych eval? Am I going to have to pay out-of-pocket for my appointments (I have Prime and we have primarily lived overseas, so I'm clueless)?

PS- Oh and hi, I'm new here. :tongue:

Edited August 8, 2008 by tomatogirl

[To be free 1]

I also have Tricare Prime south and preapproved within a few days. The surgeon will also receive a referral letter and may call you. But yes, I would call them and make an appointment....

Tricare also covered the psych eval for me, I just called the 800 mental health provider number and they told me the choices of who I can go to and put the referal on line. I am attatched to the Naval Hospital and went there for the blood test, H pylori and echo (these are some tests that my surgeon required not Tricare) but all my preop testing was covered.

The only thing they didn't cover was a 250.00 consultation fee for surgeon it was considered "educational"

The only thing I don't know if they cover would be the nutritional evaluation (again a surgeon requested item) I had paid for that out of pocket when I was going to go self pay through another surgeon (they just started covering the band when I started the process)

But all in all they have been great, they only paid the surgeon $935.00 for the surgery which I don't think was enough....now they paid the hospital over 16,000.00

I don't think I could have had a better insurance company.....good luck!!!

[Mommie_of_4 0]

Yep...call the surgeon and schedule an appointment for a consultation. The surgeon will complete the paperwork for the actual surgeon. So you are on the right track just keep moving forward. Now the doctor may have steps for you to go through but call them and find out.

[thatDEgirl 1]

I have my timeline here if you are interested...

Life With Da Band | this life of mine

Tricare was great, my PCM is what held up the process.

[tomatogirl 0]

I have my timeline here if you are interested...

Life With Da Band | this life of mine

Tricare was great, my PCM is what held up the process.

VERY helpful! Thank you! Did you have any out-of-pocket costs?

PS- I grew up in Mobile and my parents live in Panama City Beach now. I was just down there a few weeks ago. Small world!:thumbup:

[thatDEgirl 1]

VERY helpful! Thank you! Did you have any out-of-pocket costs?

PS- I grew up in Mobile and my parents live in Panama City Beach now. I was just down there a few weeks ago. Small world!:thumbup:

Neat!

So far, I have had no out of pocket costs. My nut eval was done with the nutritionist on base and my pysch eval was done through Tricare/Value Options. I did get a statement from the hospital that showed I owed $10.85 but I called them, let them know we were active duty and have no copay and they said they'll get it fixed.