Tricare Approval

KatsenD · March 14, 2008

Saw the doctor yesterday, they are submitting everything, BUT they want me to pay, up front, $600 for 6 fills, afterward. I called Tricare and the fills are an appoved, but they have to use the right code. They wont. So I'm thinking the dr wants money that he is losing, by accepting Tricare. My thoughts.

agm1 · March 14, 2008

You may be right! I am getting a little discouraged. This stress is only making me snack more. It is like my Dr does not want to take Tricare at all..

bigal62 · March 15, 2008

I also live in the tidewater area of Virginia. I was referred to the tricare site for information. I have tricare standard and the site listed the criteria for approval- 100 lbs overweight . I am going through Norfolk Surgical Group at Norfolk General ( when ever the md gets moving) are you going to use the weight loss center in Hampton? If so what is their time frame like? It is 3-5 months with nsg.

miissxangela · March 15, 2008

I am going through Weight Loss Surgery Center in Newport News.. I think that's the one you're talking about. There isn't really a wait at all.. like as soon as you get all of your stuff done, you get an appt. with the surgeon and set a date after it gets approved by tricare. how long did it take you to get approved by them? Also how much is the program fee at NSG?

bigal62 · March 16, 2008

Hi,

the fee at nsg is $495.00. the wait time is just crazy. i think it is more admin on the dr's side then tricare. I understand that the tricare approval process is very quick. How much was the fee at wlc?

miissxangela · March 16, 2008

ohh yeah I'm not about all that wait time. I was supposed to go to portsmouth naval medical center, but wait time there is 6 mos.... Wlsc fee is $750..so a bit more, but I think better than waiting!

Sgt Bob · March 17, 2008

I'm Tricare Standard and I've done all the required appointments (Seminar, Pulmonary function, psych eval, cardio, nutritionist) and my paperwork was sent in on March 6, but I haven't heard anything yet.

I started dieting the week before and if they don't hurry up, I won't need the darn band!:mad2:

daycarebusiness · March 18, 2008

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mynmann · March 19, 2008

I am so ill. I can't seem to get anyone who knows anything in my area. went to seminars and got my referall and all I can get is a bunch of Dr.s who either don't take Tricare or their hospital doesn't.

I now have an appointment on April 1st but not with a doctor I know. I just can't seem to catch a break on this. I so wish I were wealthy or had super credit... cause I'd just self pay and be done with this. Sadly, as a full time student with a part time income.... I don't have the money nor is ANYONE going to give me the money.... so I'm at Tricare and Georgia Doctors will. UGH!

KatsenD · March 19, 2008

Hi and good luck, just keep researching and asking questions. I just found out the doc office got my medical records, which they will turn around now and ask for permission to do the surgery. So the wait is on again. Keep us posted. D'

Sgt Bob · March 19, 2008

I am so ill. I can't seem to get anyone who knows anything in my area. went to seminars and got my referall and all I can get is a bunch of Dr.s who either don't take Tricare or their hospital doesn't.
I now have an appointment on April 1st but not with a doctor I know. I just can't seem to catch a break on this. I so wish I were wealthy or had super credit... cause I'd just self pay and be done with this. Sadly, as a full time student with a part time income.... I don't have the money nor is ANYONE going to give me the money.... so I'm at Tricare and Georgia Doctors will. UGH!

Have you called his office at Palmyra Surgical?

We are located at:

810 13th Ave,

Suite 108

Albany, GA 31701

Get Directions

Phone: 229-432-8484

Fax: 229-432-8487

bigal62 · March 20, 2008

Once you went to the seminar , what did they estimate your wait time to be? I have done everything, labs, ekg, xray, pshch. eval, wellness class, and will be at my last class tomorrow night (support group) , insurance class, mammogram, papsmear and GI clearance. My est. surgical month is June!! I think that is absolutely crazy. Did WLSC put you through so many loop holes? Just considering going across the HRBT and checking out WLSC???

agm1 · March 20, 2008

I started the process on 1/16/08 and spoke with the Dr. office today and they are just now sending the paperwork to Tricare. I have completed all the preop testing and nut & psych eval. I just hope everything there goes smooth. I did not get an estimated time period. I think each Dr. has thier own protocol.

miissxangela · March 20, 2008

wow! that is soo much! I didn't get an estimated wait time. All I had to do for WLSC is a psych computer test and psych consult. For tricare, I had to meet with a nutritionist, have a TSH and H-pylori lab test. Also I have to have a letter submitted by my primary care saying that I'm not addicted to drugs or alcohol and that i have no pulmonary or cardiac conditions and 5 years of medical history & physicals (basically anything charting weight). Once that is all done and IF *HOPEFULLY* I get approved by tricare, I will get my surgery date and I will meet with the surgeon, have to go to a 3.5 hour class on WLS and I believe that's it, then I'm good to go. Maybe NSG made you do all of that stuff, because of your comorbidities? I'm not really sure. And June, man.. I think it is definitely worth it to cross the bridge.. OHHH anddd! they will accept all of that stuff that you had to do at NSG and I'm sure you will get surgery quicker!

minpinmom · March 20, 2008

Now, I am just taking a stab at this, but maybe Tricare is requiring more for those that have to prove co-morbidities. I believe I must have met the 200% requirement, all Tricare required was a letter of Medical Necessity from my surgeon. I didn't have to do ANYTHING else for Tricare. My Dr.s office had me do Xrays, blood work, pregnancy test, etc. before the surgery, but not Tricare. And all of my tests were done as pre-op, I was already approved and scheduled when I did them.

When my Surgeon's office finally believed me that Tricare covers this, once they submitted, Tricare approved same day. I was scheduled for surgery 5 days latter. :-)

I know a LOT of Dr.s require testing before they do it, but everyone that I know that has been approved, Tricare didn't require anything (but we also didn't have to worry about co-morbidities)