Has ANyone used Tricare Prime and how lomg did it take for the approval

I have Tricare Prime; after my final paperwork was submitted it took less than 48 hours for them to approve surgery. Just make sure you get all your authorizations before you do ANYTHING so they'll cover all the cost. Good luck!

I have Tricare Standard (Army National Guard). It took 48 hours to get approved. As far as Tricare goes you dont really have to do anything to be approved (i.e. Tests and diet). My surgeon on the other hand has been a completely different story but this is why i picked him.

The only out of pocket i have had to pay is to the surgeon (and possibly an assistant surgeon). It was the estimated 20% (out of network charge) and i am not sure if they based this on total charges or the allowed amount. Either way it was a very small fee than most have to pay. My hospital, bariatric center, and anesthesiologists are in network so i will only owe them 15% of the allowed charge and Tricare doesnt allow much!

Good luck, and like me, be thankful you have TRICARE because i used to have commercial while trying to do this and it was a nightmare!

Tri-Care Prime has been wonderful! It was a very fast approval and my cost share was only $25! Best of luck to you!

Tricare Prime doesn't have a deductible, (unlike Tricare Standard, I believe.) All you should have to pay for is the $25 co-pay for the surgery. After following the process, starting with getting the referral to a WL surgeon from your PCM, the rest falls into place VERY easily. In my case, surgery approval took just three days. If you meet the requirements Tricare posts on their website, approval is nearly automatic. Here is what Tricare says about surgery, and who is eligible:

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Gastric Bypass

• 
  TRICARE covers gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery) is covered only when the beneficiary meets one of the following conditions:
  • Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints
  • Is 200 percent or more over ideal weight for height and bone structure
  • Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown)

  TRICARE does not cover:

  • Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction
  • Biliopancreatic bypass, gastric bubble or balloon for the treatment of morbid obesity

  Note for Active Duty Service Members: Bariatric surgery represents a major and permanent change in your digestive system that requires strict adherence to a specific dietary regimen that may interfere with operational deployment. A history of bariatric surgery is already a bar to military service and receiving bariatric surgery while on active duty may be grounds for separation. For more information, view the Health Affairs Policy 07-006.

  Last Modified:August 6, 2009

  f obesity, morbid obesity, dietary control or weight reduction [*]Biliopancreatic bypass, gastric bubble or balloon for the treatment of morbid obesity

Note for Active Duty Service Members: Bariatric surgery represents a major and permanent change in your digestive system that requires strict adherence to a specific dietary regimen that may interfere with operational deployment. A history of bariatric surgery is already a bar to military service and receiving bariatric surgery while on active duty may be grounds for separation. For more information, view the Health Affairs Policy 07-006.

Last Modified:August 6, 2009

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Good luck!

Dave

I started the process in September and had the surgery in October! It was Great!

Has ANyone used Tricare Prime and how lomg did it take for the approval

I got a referral from my PCM.. I had to attend a seminar and then from there schedule an appointment with dr. office.. the office I went through really did a lot of the insurance work for me.. I was approved right away.. I think out of pocket I paid close to 400.00 ( 200.00 for initial first visit, 25 for fitness visit and there were a couple of other things i had to pay for out of pocket) after I had all my blood wok done and chest xrays tricare approved me with in 24 hours of having the drs office call.. i started the process in october, could of had my surgery in dec but we were traveling too much so I am scheduled for Jan 13th

I was referred by my PCM in Nov of 2009, went to my first seminar in early December and started the process in January of 2010. I had surgery March 15. It would have been in early February, but tricare kept referring me to psychiatrists (for my psych eval) that didn't accept tricare, didn't do evals, were retired, only worked with children and one who had been dead for six months. After all the paperwork was submitted, I was approved within 48hrs.

I've been told by my surgeon that Tricare is one of the easiest insurances to work with, and probably the easiest to get approval from.

Everything was super easy and fast for me. I have a time-line on my blog if you want to check it out.