Tricare Help

[staplefolks 0]

I am wondering if anyone can give me a little help. I just started my journey on the path to Lap Band Surgery. I feel as though I am being screwed around with by the Case Manager and Tricare customer service on base. I have asked 3 reps over the phone and one in person on base about the requirement of 6 months with a nutritionist. The reps on the phone say its not a requirement. The lady I spoke with in person says it is a requirement and when she showed me the manual it only indicated that I would have to see a nutritionist, not have to continue seeing the nutritionist for a 6 month period. Does anyone have first hand knowledge they can give? I am stumped on where to go next. Is this a requirement for Tricare North or is this something they would like you to do???????

[Mimilou2004 13]

It is crap, you do not have to see a nutritionist for 6 months...the Military would not have 2 sets of rules.

Mimi

[Joleen 3]

I got the same run a round from Tricare!!! The reps do not know anything, you actually have to talk to the bariatric spec. that only handle WLS. I found this out by talking with my doc office. Just ask them to give you a doctor, but keep track of everything. I got a call after 5:30pm the Friday before my surgery because Tricare tried to say all the referrals weren't in, my surgery was all ready scheduled for MONDAY AM!!!! We had to fight until 6:30pm to straighten it out. The girl that handle my case in the office gave tricare her cell phone and worked on it from home!!!! Tricare requires a dietician, and a psych consult. They DO NOT require any time limit!!! That is up to your physician!!! If you have comorbidities they can ask for more ie sleep studies! I saw my doctor on November 18th and was banded March 28th. One of the reasons I had to wait is the doctors office got behind scheduling!

Hope this helps!!

Joleen

[staplefolks 0]

They wont give me any other referrals except the nutritionist. I have spoken to everyone I could possibly speak to and they keep referring me back to the case manager who tells me I have to do the 6 months. At this point I am going to go to the seminar for the surgery and then going back and telling them to give me the other referrals because the surgeon says it is not necessary to do that with Tricare. This is ridiculous Tricare needs to get there stuff together! To speak to 5 different reps in one day and none of them knowing the right procedures is absolutely absurd!! This has become a pretty common surgery they should know! Thanks for your help ladies!!!!

[jenn79co 13]

Do you have tricare prime or standard? Are you going to a military facility or civilian doc?

I have tricare prime and it was smooth sailing. All I had to do was get a referral from my pcm. I didn't bother calling tricare before hand. My doc sent the referral and it got approved. Then I went to the consult with the surgeon and they sent in my paper work and it got approved no problem

Also tricare doesnt or didnt require a nutritionist. That may be what the surgeon requires.

Mine was all civilian. I had no 6 month wait, the process took about a month and that was just waiting to get in with the surgeon.

[Dave_NW 92]

The weight loss surgeon may have an insurance coordinator on staff who can go to bat for you. I have Tricare Prime, saw my surgeon and his team Sept. 29th, and even after some extra stuff (lab work, endoscopy) I still had my surgery approval on Oct. 21st. And the approval from Tricare came through just three working days after it was submitted. I saw a physician, a psych, a nutritionist, and met with the surgeon, all on the same day. It was a piece of cake.

Good luck!

Dave

[amberakamom 13]

It was very easy for me too. The only time I ever personally talked to tricare is when they called to tell me my surgery was approved. Go see you pcm for a referral, and go from there.

[lv2h8me 2]

I have Tricare Prime, the surgeon wanted me to do a 6 month Doctor supervised diet, But I had already completed this. A nutrition appointment, and a sleep study.

[ErinMarie 186]

I have Tricare RS and it took 2.5 weeks to get approved and thats because they 'misplaced' my file. I did not have to do a 6 month diet beforehand (and I'm about 95% sure Tricare does not require it anyway). If I was you, I would go to the seminar and just go through the steps. Once the doc's office submits to Tricare is when you will really find out anyway. The doctor's insurance person will know a lot more than the Tricare people (sad but true).

[mstan76 0]

Dont give up, in my opinion Tricare is giving you the run around , I did not have to see a nutritionist for approval only a psycologist no physician supervised diet, I was approved in a week.... Please dont give up and I wish you the best of luck, Im scheduled for surgery April 26th....so nervous but sooo excited....