TriCare Approval RECEIVED today!

[Electrawoman 5]

Hooray! And, I finally found a PhD to do the psych eval they require. Will be doing that tomorrow. Waiting for surgeon's office to call back for scheduling.

[Mimilou2004 13]

Congratulations!!!!

Mimi

[Amaris 0]

Congratulations! I read your intro post, so was doubly happy to hear about your approval!

I have TriCare Reserve Select insurance. From their website, I know that they cover the lapband, but I don't yet know any of the details about what kind of hoops you have to jump through, etc. Can you tell me a little bit about the application/approval process?

Thanks!

[Electrawoman 5]

No hoops. The hardest part was finding a psychologist to do my psych eval. It has to be a PhD and it has to include the administration of the MMPI 2. Keep that in mind when you are looking for providers. (Tricare kept giving me lists of Psychiatrists and they don't do psych testing.)

I went to a seminar on the 4th of November, got approval two days ago and all I had to do was see a nutritionist once to learn the way I will be eating after band. I also had to get that psych eval. I have no real comorbidities but was 200% over ideal. Either way, I hear that Tricare is not real picky. They are supportive of WLS. My surgery is scheduled for November 30th. I will pay my coinsurance to doctor (total 352.00). I am still waiting to find out what I will have to pay for the hospital and anesthesiologist. It will be about 15% of their total fees.

Knowing that most surgeries end up costing around 10K when all is said and done, I am planning to set aside 1K for unexpected charges. Hopefully, it won't even be half that.

[Amaris 0]

Thanks so much for the information. I am going to my seminar on Saturday, and am pretty excited. My husband can't go with me, so we'll probably go to another seminar in December, if I like what I hear.

I have several co-morbidities and am almost 200% so am not expecting any hassle. I do start with a new primary care physician on Tuesday, and I hope he'll be on board. I think he will be because when I saw him during a recent hospital stay, me mentioned that I might want to consider the lapband in the future. I saw -- Why wait???

Thanks again. I look forward to hearing more about your journey.

[Electrawoman 5]

Amaris, if you have Tricare standard, you don't have to get a referral from your PCP. That's the beauty of Standard...no referrals!

Anyway, I had all my pretesting today---upper gi was WEIRD. I got the final total of costs.

My surgeon gets 392, which includes a 25-dollar book and a 150.00 deductible for the year that you might not need. My actual coinsurance cost is about 165.00.

The hospital only costs a 25-dollar copay after you have met your deductible.

My preop diet starts tomorrow---low fat, low carb, high Protein.

[Amaris 0]

Good luck with the pre-op diet and the procedure itself. I'll be following your progress!

I have TriCare Reserve Select, so I don't know if I need a referral or not. I'll have to check my benefits book or call TriWest for more information.

My seminar is tomorrow at 10AM. I'm getting excited! I'm eager to learn more about all this and meet the surgeon.

Again, good luck to you! :thumbup:

[AShaffer 0]

That's awesome! I have Tricare Prime and my surgery is on Tuesday! I was really happy with Tricare, there were no problems and I got my approval quickly! Good luck to you! And Congratulations! :thumbup:

[onetosucceed 0]

CONGRATS!!! How long did it take you from the surgery consult to the surgery date? It took me only 4 hours to get approved thru Tricare for first consult.

Donna

[RandaPanda 0]

Congratulations! Although TriCare can be a pain in the bum, I have to say my experience has been so wonderful. I'm having my surgery done at a MTF, though, so I guess the process was a bit easier.

The only downfall...my surgeon got deployed right in the middle of the process so I was waiting for him to get home from Afghanistan! lol.

Very excited for you guys and for myself as well! :thumbup:

[Electrawoman 5]

It took about 10 days to get approval. I think TriCare gave it sooner but the Surgeon's office didn't call me right away. Either way it was easy. My surgery was scheduled for less than a month after initial consult/seminar. I am on my preop diet now and have surgery next Monday.

[tysmommy 0]

Im so glad to hear others have not had difficulty with Tricare. I too have Tricare prime but I meet all the requirements. I have my consultation Dec 17 and then have to do the evaluation, the surgeon said my surgery will be sometime in February. I am new to all of this and I am hoping for a better me in the long run!

[mnkysproudwife 0]

I have Tricare Prime. Attended seminar Oct 8th. Psych Eval Oct 15th. Tricare Approval Oct. 30th. Surgery date Dec. 7th. I have no copays for anything at all. I am wondering why some of you do? My husband is AD and currently deployed to Afghanistan....I am wondering if it has something to do with AD vs. Reserve..etc. :ohmy:

[tysmommy 0]

mnkysproudwife, some people only have regular tricare or tricare standard. If that is the case they have to pay a percentage of the medical bills along with some copays. With Tricare Standard you do not have to have a referral to go to specialists or have surgeries. With Tricare Prime everything is covered as long as you meet the insurance requirements. For example the requirements for Tricare prime patients to have the surgery fully covered is being over 40 BMI or 35-40 BMI with comorbitities.

[mnkysproudwife 0]

Ok that makes sense. My bmi is 44 and I am diabetic...so I really had no problems at all. I am so glad that 2 years ago when there were no doctors who would perform lapband in colorado springs i did NOT have gastric bypass like the MTF wanted me to! I am so much happier with this decision.