Tricare Prime and Lap Band

[gdtownsend42@yahoo.com 0]

Hi my name is Gwen and i too have tri care and i had know problem they approved me with know. I had my surgery on jan 12. You have make sure you do what ever there requirements are and they will approve it in no time. I think you have to have tri care standard if you call tri care they will tell you so that you can switch to the one you need thats what i had to do. I hope this information herlped you.

Gwen

[connie45331 0]

hello,

I have tricare prime and I have had no problem at all. They have paid 100% of everything. I would rather have tricare prime then tricare standard. We used to have tricare standard and we would have to pay a co-pay and part of all of our hospital bills. With prime we dont pay anything. But thanks anyways!

[help1977 0]

Hello Everyone, I also have Tri Care Prime and I had no problems. After I got everything done my doctor office fax it all in to Tri Care and within 36 hours we got an answer back saying you are approve. The only thing that I don't understand is everyone is saying we didn't pay anything. Yes Tri Care is Good and has alway been good to me and my family I still have to pay my co-pay of $12.00 and nothing more. And trust me that is okay with me because it is not like I pay a whole lot for Ins every month anyway. And I'm not sure if Tri Care Prime is different for Active and Retired. We are Retired. All's I know is my surgery is April 29 and I can't wait I wish everyone good luck with everything. And I hope everything goes great for you.

[connie45331 0]

Thanks! :scared2: Good Luck to you!

[talkalot1981 5]

I was wondering if anyone else that had TriCare if they had any out of pocket expenses? I know people that are retired and have TriCare will have out of pocket but I am wondering about active duty spouses? Thanks Jennifer

[connie45331 0]

Hello! So far I have not had to pay anything but I did have to pay $120.00 to see the nutritionist, she don't exept any insurances. But I can turn it into tricare or claim it on my taxes. I have tricare prime, and I have had no problems so far. I go April 24th, for a procedure to check me for gerd (acid reflex). I have already been to the seminar and consultation with the surgeon. Oh and I also had to pay $25.00 for the seminar. Good luck to you!

[talkalot1981 5]

I talked to my surgeons office and I have to pay $50 for the seminar and another $200 for something else. I can't quite remember what thats for. I go to the nutritionist on post so I won't have 2 pay for that. I just couldn't remember what the other was for.

[anymouse 0]

Great post.

I am currently tricare standard due to being non-command sponsored in Korea. We are waiting for our sponsorship to be confirmed and we will then put back on prime.

I saw my PCM for about 2 minutes and he put in a surgery consult immediately. That is scheduled for the 24th of April. I think being here may actually give me some advantage what with the use of on post hospitals and the like. I don't think I'll have any problems being approved, BMI 44, hypothyroidism co-mord, just worried that they might not do lap-band here as PCM only knew that they do bariariatric surgery but not the specifics.

[help1977 0]

I was wondering if anyone else that had TriCare if they had any out of pocket expenses? I know people that are retired and have TriCare will have out of pocket but I am wondering about active duty spouses? Thanks Jennifer

Hello I have TriCare Prime and the only out of pocket I had so far is $12 to see the surgeon, $300 for the nutritionist, I did not have to pay for the seminar and $12 for each test I needed. The hospital call the other day and they said the only cost I will have for surgery is $25. I really don't think that is so bad.

[savannahsmommie 0]

Hello, I am Tricare Prime. I saw my doctor on 4/7/09. Got consult apprv w/ surgeon on 4/13/09. I opted to use an out of network provider and had my seminar and consult on 4/14/09. I did lab work on 4/15/09 and my EGD is on 5/10/09. Haven't had the actual surgery apprv yet, but crossing my fingers!- ASH

[KOLaficionado 0]

Wow, I'm really surprised that those on Tricare Prime have had to pay anything. My husbands not retired if that makes a difference, but I haven't had to pay a penny for anything except $3 for prescriptions. I've had three sleep studies, a ultrasound for my liver, an EKG, a 24 hour heart monitor, all with no copay. My psych and nutritionist appointment will be free as well, although I did have to go to a hospital in Humana's network for that to be the case. But, that said, if I'd have had to pay a few hundred for all of that I'd do it gladly!

[wintobethin 5]

Tricare Prime here. My husband is retired AF and we live in the Dayton area. Had my surgery done at Wright Patterson AFB, Dayton and the only thing it cost me was $15.00, that was because I had to spend the night (sleep apenea) that was the rules otherwise could have gone home same day! Needed NO pain meds at home or in the hospital, no other cost, besides $12.00 copay for Psych eval. Went to nutritionist on base and had EKG, lab, chest xray done on base, no other test needed! So for $27.00 my band is paid for!:sneaky:

[Vnenita02 0]

OK so I have a question also about getting approved my issue is that I am going to see my doctor tomorrow to ask about Lab band and I need it approve quick. my husband is active reserve until 9/01/09 and then he is back on reserve duty and off of TRICARE Prime. So I want to know if I can be approved and have the surgery with in these 3 months if not I am out of luck and will have to wait untill next year when I go back on my Aetna insurance. HA any gotten approved and banded with in 3 months. I am 5'6 and 283 lbs I had hypertension since my 1st pregnancy and got sick in 2006 after having my son they did a EKG, endoscopcy ( think i spelled that right) and a sono on my gall bladder.

[talkalot1981 5]

Try to schedual all of you appointment for labs, EKG, UGI, ect as soon as you see your PCM. It has happened fast for some people. I have been waiting since April. well actually march but it is a long story. My fault. Anyway, just try to get everything that needs done, really fast. Sorry I can't be more help. Jennifer

[katwmn63 0]

just to clear things up... it is NOT required that you have had a surgery for wieght loss before....that is only one of the possible ways you can qualify with Tricare.

if your ideal weight is 115 and you weaigh 230 (or more).. then you are at 200% of your ideal weight -this is another way you qualify.

otherwise, if you are 100 lbs over your ideal weight (or more) and also have a comorbidity - (a medical condition related to being overweight), then you also qualify.

i hope this helps... don't be discouraged...you're there:)