what is Tricare talking about

[katwmn63 0]

i am so confused and frustrated!!

i have been waiting for my tricare approval, since the 12th. everyone else on this sight can go online and check there status (approved/disapproved)...i can't until i get a security code in the mail after my registration. i am in florida trying my best to enjoy a vacation, so the security code is likely sitting in my mailbox back home in illinois.

so instead i call tricare...everyday. the first day was a false "approved", yesterday was "still peding under medical review" today i kind of got the same thing but was put through to a medical manager. here is what she said. "this is a limited benefit..you must meet certain criteria for tricare to pay" kk thanks, i knew that.. " then, "you don't require preauthorization-when is your surgery scheduled?" i told her we were waiting for tricare approval...she said, "oh, well this doesn't require preauthorization, as long as your doc sends in all the clinical info showing you qualify..." i said, why does everyone else get an approved or disapproved?...she said "well your doc will get something faxed in 7 days or so, but no preauthorization is required for this benefit.

why does all other Tricare folks that i have read about here get an answer in an average of 2 days that says simply "approved or disapporoved" ? I am very confused...very, very confused!!:wink2:

Edited June 17, 2009 by katwmn63

[Kristine73 1]

I have tricare prime. I don't know which tricare you have. But, yes you need authorization. I find dealing w/the people over the phone aren't as 'educated' on all matters. Most just have a basic knowledge to pick up key words and transfer you to this department or that one. I don't know about tricare, but I do know w/another health ins co, phone reps were trained to keep phone calls under a certain time. Fast call-turnovers translate into 'effenciency' on paper.

I think there is a dept you can call about trouble logging on. Ask if they have 'on-line assistance.' Most places do. Maybe you can call them and say you are on vacation and need to print a temporary ins card (wink wink) and they can give you your code.

Good luck and try to enjoy your vay-cay

[chantel03 0]

are you getting it done on base or at a MTF? ive read on here that if you get it done by a military doc then you dont need tricares approval.dont know if its true,but its an idea.enjoy the vacay. you are probaly approved and wasting a perfectly good time.dont stress

[talkalot1981 5]

Well I would call back and talk to someone else. Oviously they don't know what they are talking about. You do have to get authorization before you can get surgery. Or even have an appointment. Online it says that if you go to an appointment before Tricare approved then they will not pay for it. The first time I called Tricare and found out if I was approved they said yes. I was so excited. I asked if they had send thing to my surgeons office and they said yes. Well I called my surgeons office and they said they didn't have it. So I called Tricare back got a different person and they said "Well we can't fax it till tomorrow because it was just approved today and all the paperwork needs to be ready before we can fax it, it will be ready tomorrow" Well I told them what the other person said and they said they were wrong. So I called Tricare back again and talked to a 3rd person. Well they told me the same thing as the second person. About not being able to fax it till the next day. So maybe you should just call back and hopefully you get a different person. Sorry its so long....LOL Jennifer

[grneyedvenus 0]

Hi, first off, take a deep breath and relax--you're on vacation. Then, when you get back you can deal with the process. I hope this will help you a little.

I had my surgery done under Tricare Prime. This is what I had to do: First, I had to go to my Primary provider. The primary had to make a referral to the surgeon. Tricare approved the referral. Once I got the letter in the mail (couple of days) I could make my appointment. When I went to the surgeon they made the referrals for the psychological evaluation and dietary consult as well as submitting the qualifying info to Tricare. Once all of it was submitted, I was *approved*. Tricare sent a letter to my Primary provider and the surgeon. At this point, I could then schedule the surgery. All that Tricare required of me was that I was at least 100#'s overweight with two co-existing morbidities or at least 150% of my *ideal weight* with no co-existing problems. The process was fairly simple, quick, and painless. But, my surgeon's office was VERY knowledgable and knew exactly what paperwork to send and in what order.

The first step is that you have to have a referral from your primary caregiver to the surgeon. From there, your surgeon should be up on what has to be done. And, you can call and check progress with Tricare. But, not all of the reps know what they are talking about--so if you get an answer that just seems to be off from what you've been hearing, call back and speak to someone else.

Good luck!!! :blushing:

[Iris_L 0]

I'm no expert but it sounds as if they are going to approve your surgery. Enjoy your vacation and do not stress. :blushing:

[melmarlem 0]

katwmn63- It sounds like you have Tricare Standard which is very different from Tricare Prime. With Tricare Standard you do NOT have to have approval or preauthorization. With Tricare Prime, you do!! For Tricare Standard you do still have to meet the same criteria for surgery. You need to have your surgeon send proof of this to Tricare in order for them to pay for the surgery. I also have Tricare Standard since my parents are retired ARMY. I was confused as well :biggrin:

[L12 13]

^What melmarlem said!:biggrin:

I have Tricare Reserve Select, which is very similar to Standard. Unlike Prime, I did not need a referral or preauthorization for the consultation, but I did need it for the actual surgery. Sounds like the lovely Tricare workers may have just been confused about what you were asking--but that NEVER happens, right? :thumbup: