Just starting- Tricare in San Diego

[yepitskelly 0]

Hello. I went in to my yearly visit to my PCM and she gave me a ref. to Dr. Santiago Horgan at UCSD Center for Obesity. She was happy to hear I have been thinking about Lap band. We discussed Gastric Bypass in the past but she was not into the idea since I have minor hypertension and no other issues. I am 5'5 1/2 and 303 lbs. and have been 275+ for over ten years (overweight my whole life).

I was wondering if anyone could give me the process after this point. The ref. says to call his office next week to make an appt. What happens now and later. I have been reading a lot on this site- but it all gets so confusing. I know I have a BMI of 49 and I am almost 200% over so I am guessing it should not be an issue with approval. We have Tricare Prime. I assumed she would send me to Balboa military hospital but sent me to a private for a consult. Anyone who could give me some insight it would be helpful.

I am really excited if this is something that will happen. I was looking to do it last year out of pocket in Mexico but my husband talked me out of it. Thanks and I am looking forward to becoming one of the many banded soon.

[JamieNP 20]

You should have no problem with tricare paying for your surgery as long as your surgeon is within network. You are 100 lbs overweight and have a comorbidity, meeting the requirements for tricare. Call your surgeon and make the appointment. Go head and make an appointment for a psy consult (you can self refer for tricare), go to an informational meeting, go to a support group meeting, get your labs together.

Good luck!!

[yepitskelly 0]

If my PCM ref. me to someone, it should be in my network, correct? When I was looking on line with Tricare it said that USCD hospital (which sends a link to the obesity clinic) is in the network but the specific doctor is not. So I was not sure.

[JamieNP 20]

I have heard people having problems with it getting approved because their doc was not a tricare doc. Just call tricare and make sure.

[thatDEgirl 1]

If you are interested, my journey with Tricare (timeline) is here

Life With Da Band | this life of mine

[yepitskelly 0]

I actually read your story before when I was in the "I think this is for me phase". It was one of the stories that turned "I think" into "I know". Hopefully this will not become a trainwreck. I hope for the best.

[thatDEgirl 1]

Glad I could help a bit. No regrets here, I am saving my life:-)

[Mimilou2004 13]

Hi, it took Tricare Standard about 10 minutes to approve me. My docs are NOT in the Network and I have a 25% co-pay, at least. It is all the other tests and referrals that are holding me up. I am 100 over with 3 co-morbidities.

[pwoods5015 0]

I am just starting the process also - and after a LOT of research looking for doctors (and 3 seminars later), I believe Dr Horgan is the only one in the San Diego area that takes Tri-care. His was the first seminar I went to, but I looked further because I was told there was a waiting list a year long. Apparently they have done some re-working in their system as I now have an appointment in September :>) From what I saw at the seminar and the contact I have had with his staff, it looks good.

Tri-care was very quick to approve the referral for the consult, although I had to get the referral to Dr Jorgenson as Dr Horgan is not on the tricare list. As for the surgery - we will see.

Start with the seminar at UCSD - you can't get an appointment without it.

good luck

[jimsgirl624 0]

I have Tricare Standard and his office is telling me that I need a referal from a primary care doctor or else I will have to pay $1,000 out of pocket. Do you have Tricare standard? I thought that with standard it gave you the option to see who you wanted without a referal.

[pwoods5015 0]

I have Tricare Prime and you do need a referral or it becomes Point of Service, which is high dollar out of pocket.

Oh, and be advised that Tricare does not approve referrals to Dr Horgan, but does for his partner Dr Jacobsen - not sure why. As best I can tell, insurance patients are at the bottom of the list for dates of surgery - I have had an approval for surgery for almost 2 weeks and still have no idea when I MIGHT be scheduled for surgery. I am at least trying to find out if it will be before the end of the year as I have to plan for my spending account. And I still have no idea how much I will be out of pocket.

So, be advised getting the referral is half the battle.

[jimsgirl624 0]

Prime is different from Standard. Standard allows you a little more freedom to seek care from outside help with the knowledge that you will pay something out of pocket. It also means that for the most part you no longer need referals. I think that is where Dr. Jacobson's office is getting confused. There are so many different insurance's that and most require a referal, so they apparently assume that everyone needs a referal. No so with Prime.

I am going to call Tricare tomorrow and settle this once and for all. Thanks for your help.

[losingjusme 12]

welcome to LBT - best of luck to you