New here: Tricare & Psych Eval question

[Allformyson 0]

Hi, anyone else here using Tricare Prime? I am interested in the lap band surgery and my PCM is onboard. I'm only waiting until my 9 m.o. reaches a year and is weaned from breastfeeding. In the meantime I am trying to get all my requirements meet..i.e. nutrition appt etc. My doc said she wouldn't do the blood work until I am closer to ready.

However, I am having trouble finding a psych here that does the evaluation. I am not near a military hospital (I'm in eastern CT). I did find one but she said I need authorization from Tricare but I was told this was a self referred appt. Does anyone have any experience with a civilian psych? Do I need to call Tricare for authorization?? Thanks!

[dl2418 0]

Have your PCM send a referral for prior authorization to the person you found that is able to do it. He should be able to specify that you need an MMPI (or at least that's what my surgeon requires) and this is the only person in the area that performs the test needed for surgical clearance.

Good luck. I will be attempting the same thing. If that doesn't work then I will just pay out of pocket to get it done.

[sunflwr78 0]

I have Tricare Prime(South). I had to have a referral from my PCM and it was to a civilian psychologist. They would not refer me to someone on base. I did not have to pay anything out-of-pocket. My visit was a breeze. It really and truly was just a visit. I was not administered any type of test. He said that Tricare only wants to know 3 things: Have I ever been hospitalized for a psychological disorder? Have I ever seen by a psychologist on a regular basis? Have I ever been prescribed any type of psychological drug? We talked about my husband, our dog, and my family and that was it. Super easy. Hope yours is as easy as mine. Good Luck!

[MrsMAJL 0]

I have Tricare Prime and didn't have to have a psych eval. I also didn't have any other tests, I just got a referral from my PCM and that was it. I had my surgery just under 7 months ago, so I'm wondering why it seems like everyone else needs to have one and I didn't. I find it hard to believe that they changed the requirements in such a short period of time, it took them long enough to cover it.

[kmcoolone 0]

With Tricare Prime, you need a referral just to sit on the toilet or you will have to pay 50% of the total costs. Other than needing a referral for everything though it is great.

[shouldidoit 0]

I have tricare prime south and I had to get a referral from either my WLS ( they werer hesitant to get me one) or my PCP ( they did it right away they referred me) . I did have to call about 10 different psychs before I found one who did evals for WLS.I am still trying to get tricare to find a nutrtionist. according to someone at tricare they willl pay for a medical nutrition appointment as it is a prerequisite for surgery. My PCP put a referral in for me last wed. I have not heard back.Any one have any luck with this??

[Allformyson 0]

I found someone and they even have an appt tomorrow! :tongue: I had found one the other day but they didn't have an appt until Dec.

She said the report would take about a week. Then I guess I go back to my PCM for the blood work and referral?? I'm looking to do this around Jan/Feb.

[JamieNP 20]

I have Tricare prime and did not need a referral. If you go to Tricare's website you can find PSY docs/NPs that are in network in your area.

[Allformyson 0]

Yes, thanks. There are a bunch that take Prime, but not all do this type of evaluation.

[mljalways 1]

I have tricare prime and couldnt find anyone in the area to take it and my pcm said when it id for physchology they wont refer. I was lucky enough to be able to go to a base near the house.

[dl2418 0]

I am currently seeing someone who is a Tricare covered psychologist, but they will not do the test I need for surgery because they said Tricare won't pay for it. Yet Tricare is paying for my weekly talks that I self referred to. Go figure.

I have Tricare prime and did not need a referral. If you go to Tricare's website you can find PSY docs/NPs that are in network in your area.

[JamieNP 20]

I don't know what kind of test they think they need. All they need is a referral. I just talked with her, she asked me a couple of questions...and then wrote the referral.

[tomatogirl 0]

I have TriCare Prime (North) and I had my psych eval about a month ago. I didn't take a test- I just spoke with the psychiatrist and he wrote up a letter saying I was good. That was all there was to it. The hardest part is finding a psychiatrist to do it.

[dl2418 0]

My surgeon requires that the psychiatrist perform an MMPI. They have particular paperwork they request be completed by the psychiatrist performing the evaluation. And we all know Tricare only requires what the surgeon requires. This is a requirement for my surgeon.

I don't know what kind of test they think they need. All they need is a referral. I just talked with her, she asked me a couple of questions...and then wrote the referral.

[sunsetskies 0]

:wink5: I have tricare prime as well. The way it worked for me...

~Sept. 22th - I had an apt with my PCP for blood pressure medication, asked about the lap band, she said that tricare just recently started covering it and she would put a referal in for me...

~Sept. 23th - the nutritionalist (Erin Wilson) on base called me the next day and said she had an apt available that day so I took it.

~Sept. 23th - saw nutritionalist who went over how I would be eatting before and after the surgery and gave me some literature on eatting with the lap band.

~Oct. 1st - Saw Surgeon. I had a few issues with finding a Surgeon in the Corpus Christi area that was in the network, but finally found Dr. Griffin a general surgeon who is a bariatric surgeon as well. He said I needed to make an apt to see the nutritionalist one more time (total of 2 visits with her), have 6 weeks total wait before surgery, and a psychologist approval (he had a list of 2 of them in the area that were for Tricare) so i called for an apt.

~Oct. 27th - Saw my nutritionalist one more time to get my pre-op diet instructions. (Dr. agreed that I could follow the nutritionalist on bases diet)

~Oct. 27th - :ihih:(same day as nutritionalist apt) Dr.'s office called to say I was approved with tricare (before i went to the counselor for approval lol.. that was weird)

~Oct. 30th - and then went to the counselor (Aurora Ortiz) who sat with me for 13 minutes and asked general questions about my family and the surgery, gave me an approval paper to give to my surgeon.

~Nov. 4th - went to see my surgeon last week for surgery day instructions and orders for the hospital to do my preop blood work, xrays, and get registered.

~Nov. 4th - :smile2: went to hospital for pre-registration stuff. (blah took 3 hours of waiting around they were so busy)

~Nov. 10th!!!! :tongue2: - surgery is scheduled for Monday November 10th!!!

So all in all.... It went suprisingly fast. I am glad this is something that I have wanted for years now and that I did a ton of research on prior to initiating it all, otherwise I would have just been like a deer in the headlights.

Sunsetskies

32 years old...5'9" and 261lbs

Hypertension and Tachycardia for 12 years