Tricare Hell...

[savannahsmommie 0]

I am Tricare prime and have been trying to get through this journey. I started talking to my original PCM about four months ago. He kept trying to discourage me and tell me to diet and exercise. The doctor I work for is a weight loss specialist so he did this great diet plan for me and I gained weight. I went back to my PCM and still wasn't getting anywhere. I switched to another doctor and on the first visit he ok-ed me to meet with w/ a WLS.

I wasn't comfortable with the surgeon Tricare sent me too, so I did a free consult with another office. I am 103lbs overweight. I have HTN and knee pain. I am 5'11 and 244lbs. I qualify and the surgeon said it shouldn't be a problem. I had my EGD, EKG, U/S and Blood work done. My referral was sent to Tricare about two weeks ago....with no answer. I called and they won't even tell me anything.

Anyone else have major problems with Tricare?

[mljalways 1]

I followed my authorization request online and it only took 4 days. Good luck to you and dont give up!!

[RestlessMonkey 7]

I'm Tricare standard. I had to use a "Center of Excellence" surgeon. He's head of bariatrics at a local hospital and they had someone (thank you Nadia!) do all the paperwork for me. From seminar to surgery was 1 month and my approval took about 48 hours.

[pappyny 0]

I have Tricare Prime as well. From the time my paperwork was actually submitted, it was about 4 days to approval. Could your paperwork have been sent in a little later than you think and that's causing the delay?

Hope you find out something soon. I know first hand the waiting is one of the hardest parts.

[AlaskaGirl77 0]

We have Triwest (prime) and took 4 days from when my surgeon sent the request. I hope for an answer for you soon!

[savannahsmommie 0]

I can't get an answer out of my surgeon's office now. I have been calling all day yesterday and today...EH!

[ThinWithin 0]

i had a HUGE debacle getting tricare to approve my surgery. i ended up calling them everyday or every other day for 2wks and FINALLY they answered me. I have no clue what the hangup was. I have tricare prime and felt like they dragged their feet, also i dealt with some liason between tricare and my surgeon at healthnet federal services that was IDIOTIC! the day before my surgery they called to ask me if i was sure i wanted to have my gastric bypass. I was like ummmm NO i'm not having bypass!! and i had to argue w/her for a few moments until they finally believed me.

[savannahsmommie 0]

AHHHH! So I can been calling Tricare and my WLS office for the last two days. I finally got through to someone at the WLS that had some knowledge of what was needed. I got their fax number and called Tricare back because they needed to know what Fax number the auth request was coming from. Turns out they never faxed it in!! So I call back to the WLS office and they argue and say they did and they will fax it again. They still have not faxed it! I am so pissed and angry I started crying....

[savannahsmommie 0]

So It's finally listed on their website. For some reason the follow up care and fills got approved just not the actual surgery yet! Can you believe that?! HA. Wish me luck!

[savannahsmommie 0]

I was approved. Had pre-op yesterday and my surgery is scheduled one week from today! YAY!

[RestlessMonkey 7]

Good for you! You've had a dreadful time! Now you get to be excited!

[charms 1]

Tricare was very fast for me. They faxed the letter on 4/29 and I had my approval online 4/30 and my surgery on 5/12.

When all else fails with tricare, call and ask for a case manager. Things will get done much faster with someone you can specifically call and contact.

This was the first time tricare was so easy.

Watch out though - if your surgeon typcially does surgery with an assistant or two....you might get denied after the it is done.

They require TWO Surgeons during the procedure.