1st Visit @ Metabolic Center...how Long Too Pre Auth Tricare?

[rklewis2 1]

A bit confusing! I have Medicare & Tricare; went to Support group November! Loved the Center!!! Went to Seminar!!!! Made Appointment with Metabolic & Weight Loss Center; went today! Submitted general paper work (Insurance) & (Apnea-HTN-Severe Asthma)..had more -they stopped there! BMI 37 As i understood it-MEDICARE does NOT pre authorize ; and though it is my Primary (they may not pay); however they "expect" Tri-care to Pre authorize (? even aware of the fact that Medicare is Primary)-is that to be expected? How Many KNOW prior to surgery-that their Insurance will pay (and) What amount it will pay? Kinda nervous about getting hit with a big bill after! Thanks! I have had already: sleep apnea (repeated study) since I have a 5 yr history of-Recent EKG-In PT currently with Degenerative Disc disease/Osteoarthritis-(what will I need to get from PT -since I am already a patient thought-i-would ask??????) and have Internist and General Doctor; both whom will write letters/request approval for me. HELP! Full of MANY QUESTIONS!!!! Its a Maze and any direction sense appreciated -as I want to be INVOLVED and DO whatever I can to HELP press in the first time! (I lost 80 + lbs twice since 1999-and regained plus 130 each time)pretty well documented with Phentermine and Atkins (but not sure how to prove the last one))))

[Corrigan 75]

I had the same problem, have the surgery and hope Medicare would pay for it. What made it worse is that my

secondary said they would pay IF Medicare paid. They did and everything turned out OK. I had called Medicare

earlier and one person said they wouldn't pay and another said they would. Who was right? Made me a little

nervous. You have two co-morbidities and a BMI over 35 so you should be alright, but it sure would be nice

to be certain, going in. Well, good luck, and I hope your surgery goes as well as mine.

[marfar7 1,528]

I also had Medicare - but my doctors office preauthorized it. It only took about a week. I had hypertension and a BMI of 40 tho. My surgery was about $13,000 and I paid about $1100 out of pocket. The hospital let me make pmts too. Good luck to you on your surgery! I'm 2 yrs out.

Marci

[Damander 11]

I have Tricare Prime and I found out two days after it was submitted that I was approved..if they submit to Tricare, they are SUPER fast!

Hope this helps!

[Damander 11]

btw, Tricare pays 100%. I don't know what they will pay since you have another insurance, but your out of pocket should be zero