Tricare - Center of Excellence???

[Sgt Bob 1]

Not sure if this is completely true, or if it is just a problem I am having, but my Dr. wanted me to do outpatient, and Tricare amended the approval so that it will be inpatient. I don't know if it has to do with the Hospital is a Center of Excellence and Outpatients aren't? I couldn't find any surgery center (outpatient) on the Center of Excellence . . . Anyway, just thought I would add that bit of info for yall.

The really nice woman I talked to at Tricare North told me it was listed as an "inpatient" procedure. That was for Tricare Standard and she told me I could go anywhere that accepted Tricare (the good thing about Standard).

[irideaqh 0]

My surgeon is listed as a "Center of Excellence" surgeon as well as the hospital he is affiliated with. He also performs LB surgery at an outpatient Surgical Center and wanted me to have my surgery there. However, according to the insurance person at his practice, Tricare requires me to have my surgery at the "Center of Excellence" hospital, which is fine with me. I am not sure if that means I will be spending the night in the hospital or not. Guess I need to check into that.

Minpinmom - when is your surgery?

Lisa in OK

[minpinmom 2]

I am still waiting to find out - the Dr.s office says Tricare is using "unfamiliar" codes, so they have to have their office manager call and verify everything. Hopefully I will know on Monday. It will slow my progress down, having to be in the hospital overnight, most of Dr. Spiegel's surgeries are outpatient, so I assume I will have to wait until there are enough of us overnighters for him to spend the entire day at the hospital. Hopefully it will be soon. I am so ready for this.

[Emily'sDad 0]

I went in to meet with my PCM today to ask about LB and we discovered that I now have fairly high blood pressure. That was a bit of a surprise. Maybe just nerves? Anyways he gave me a referral to see a surgeon for LB and have a sleep study. Is that the big hurdle? Or is it getting insurance approval? What can I expect at the surgeons office?

Still can't believe my BP jumped so much.

Brad

[minpinmom 2]

Hey guys, I am having surgery Tuesday the 19th (FEB) at University General in Houston by Dr. Spiegel. Boy did it go fast. Found out the approval was good, they called me on Wednesday, had pre-op on Friday, start Clear liquids on Monday and surgery on Tuesday.

Tricare is requiring all of their patients to be inpatient. (per Tricare rep) All I have to pay is $11.00 a day for overnight hospital copay :-) Gotta love Tricare!

Wish me luck!

[irideaqh 0]

Congrats on the surgery date Wendy. Boy that went fast!

I had not heard anything about having to be inpatient. The authorization I received in the mail from Tricare actually says outpatient on it. I guess I need to call them and check into it. I would hate to get to the hospital for surgery and then find out that I have to stay overnight.

My surgery is March 17. I have to do dietician, psyc apppts and go to a LB support group meeting (required by my surgeon) All that happens next week, but then my husband will be gone for 2 weeks TDY at Sheppard AFB so I needed to wait until he gets back home.

Good luck to you and let us know how it goes.

[minpinmom 2]

My hubby was at Sheppard for tech school and training - I stayed in Houston - not a fun base - all that training - I got stopped everytime I went to visit him. The Security Forces are so serious about their job there!

Hope things go well.

[Sgt Bob 1]

Luck Wendy and Lisa! Congrats to ya's!:cheers2:

I met with the surgeon (had attended a seminar 4 months ago), saw a Pulmonologist, Physical Therapist, have a physical therapy appointment tomorrow (treadmill cardio stuff), psych eval Tuesday, pulmonary function test (I have COPD) Thursday morning and Dietician Thursday afternoon.

It's all happening pretty fast, hopefully I'll have a surgery date real soon.

[irideaqh 0]

Good luck to you Bob. I am sure you will have a date in no time.

I have been really impressed with how fast Tricare has been approving people. It may have took them a while to decide to cover the LB procedure, but now that they have they seem to be moving pretty quickly in approving people for the surgery. I am so glad I decided to wait instead of trying to self pay.

[wifeof46pilot 0]

I went to the doctor on January 30, 2008. My doctor put the request in for the lap band and I received word from my doctor that I was approved on Feb.11 they said that they had just turned in the request on the 7th so the approval came fast. My surgery is shceduled for Feb. 21. Tricare works fast.

[Emily'sDad 0]

Wow that really is quick. I am still waiting for my PCM referral to be approved.

My wife is an instructor pilot here at Sheppard AFB. What a lovely place Wichita Falls is...not!!! haha

What website do you guys use for checking your approval status?

[MonicaFattay 0]

Please help me to understand......OK I was a self pay (mexico) patient because at that time tri-care was'nt doing the lapband or so I was told. So I called tri-care to see if they would at least cover my fills, and I was told yes to get in touch with my PCP and get a referrel which I also did taking off of work to do so. After it was all said and done I got the referrel from her and then tried to call the Hosp. to set up fill appt and was then told that they wouldnt touch me because I had the procedure done in Mexico. I am at Ft.Hood TX anyone else had this problem?

[irideaqh 0]

Wow that really is quick. I am still waiting for my PCM referral to be approved.

My wife is an instructor pilot here at Sheppard AFB. What a lovely place Wichita Falls is...not!!! haha

What website do you guys use for checking your approval status?

Brad,

I check for approval status at Humana Military

Then choose "online beneficiary services". You have to register to access the site, but then you can check your referral status, see claims that are paid, etc.

We are stationed at Tinker AFB. My husband is coming down to Sheppard the first two weeks of March for a class. Any good places to eat down there that he should try?

Lisa

[chell1957 2]

My primary care doctor submitted my referral to Tricare South for a consult with a surgeon for lap band. I just got a phone call from a Tricare rep and she said that they wanted to refer me to a surgeon who is affiliated with a "Center of Excellence".

Has anyone else had Tricare request this? Luckily the surgeon my doctor requested a referral with is in the same practice as the surgeon that Tricare wants me to see and I had not really had a preference of one over the other.

So hopefully all is going well and I am on track to getting the Lap band. I am very happy with how quickly Tricare responded to my doctors referral request. It has only been a couple of days.

Lisa in OK

Hi. I use the Veterans Hospital in Philly PA and as we both know Tricare is offered to retired military and family. My point is that my hospital is a "Center of Excellence" and I THINK it means they have to meet a certain standard to make that claim. Sounds to me like it is supposed to be a good thing for us patients. Chell

[Emily'sDad 0]

Lisa,

Thanks for the help, I got set up on the website. No news on the referral yet, but at least now I know where to look.

If you like Italian food then Toscani's is my favorite.