Hey all,

I'm in the process of trying to get approval for surgery from tricare, already have the referral from my pcm...I just wanted to how everyones journey to getting approval went...And whether or not you had your surgery at an MTF or of post...Well hoping for a few responses thanks!!!!

If you are Tricare Prime, you should have a $12.00 Copay for certain Dr.s Appointments. (non-MTF) Same as if you go to your Dr. for a cold, you have a $12.00 Copay unless you have maxed out for the year.

We've been Tricare Prime for 9 years now and the only thing I have ever had a copay for is prescriptions done through an off base pharmacy or the mail order service. I even have an off base PCM, no copays.

Are ya'll retired? Maybe that is the difference? I just looked online, that must be the difference TRICARE Cost Share .

Yes, we are medically retired.

Hello to all tricare prime people! I am also new here to LBT. I rec'd the approval from my PCM and waiting for people to contact me from the Scott & White program in temple. I have tricare-prime and just wanted to know if anybody out there has gone through S&W? I am just at the 100lb mark, BMI 41, and have pre-hypertension; but if I lose 10lbs my ins. wont pay. Does anybody know how long is the process to surgery? I have been reading this forum for about a month and it is awesome.

I am just starting this process, but from what I understand, it's pretty easy if you meet Tricare requirements. We are stationed at Fort Bragg and we have a Biractric Center here on post, so basically they won't see you if you don't meet that criteria. I have done 3 classes (2 support groups and 1 education class), got my referral from my PCM, and had my consult with the surgeon. Now I need to do the nutrition, phys. evaluation, labwork, and 3 more classes and I'll be done. :biggrin:

Tee- The whole process took me almost a month. From PCM visits to surgery, was only like 23 days. It was not long at all. The part that took the longest was getting my records from my ob/gyn, because that was the only doc i had seen in 5 years. So in reality it took me about a month and a half. But from the time I saw my pcm to surgery was less than a month.

Here they say 3 months cause you have to go to 3 support group meetings and they only have one a month.

Hey!

Thanks for the info. I am a Navy wife too. I am trying to be patient, but the waiting and not hearing anything drives me crazy:eek:. I talked with them today and they said that the business office will contact me this week or next week to set up appointments. Thanks again and good luck to both of you with your LB journey!:biggrin:

It didn't take too long for me. I had all my medical paperwork transferred over (less than a week), the surgeon's office submitted (took forever, they didn't believe me that it was covered). Once they actually submitted it, Tricare approved me within minutes. Then, once again, the Surgeon's office took forever (they insist on waiting for a hard-copy of the authorization instead of the online version. Finally, after 2 weeks, I got a copy of the Auth from my regular PCM and had them fax a copy to my surgeon's office. Once they received it - I had pre-op the next day and surgery 3 days later!

It is the paperwork that takes so long. I think it took about a month, but would have taken a couple weeks if not for all the hassle.

Thanks for the info. I met Dr. Spiegal in 2006 when I was looking at the LB, but tricare wasn't approving it then and I WAS NOT doing the GB. He was nice. I have lived so many different places with so many doctors. I wonder if I should request my records from all those places just in case. I probably will, just so I will have them. Did you have to stay overnight? I have read on some posts that Tricare likes for you to stay overnight.

PCM referral:thumbup:

Info Seminar:thumbup:

i had to stay overnight, but it wasn't bad! It was a nice break from my kids! lol!:biggrin:

Tricare required me to stay overnight - Spiegel had said I could do it outpatient. I am actually glad I had to stay. The Hospital was totally Posh - flat screen TVs in all the rooms, all rooms private, valet parking for everyone. It was an upgrade for the night :-)

I love Spiegel - he is totally no nonsense. His front office could use some help, although, I have seen improvements since I have been going.

i was one of the first to be approved when tricare started with lapbands. I got my approval from my pcm to see the surgeon. The surgeon sent in a letter of medical necessity to tricare. Once they received this, i was approved within 24 hours. I didn't have to have anything else for tricare. I had surgery on 2/19 and had my second fill yesterday!

So far i have paid :

$12 for my initial visit with my pcm

$12 for my initial visit with the surgeon

$11 for the overnight stay at the hospital

$12 for my first fill

$12 for my second fill

i am a pretty happy camper!

i am new to this. I also have tri prime and did not know if the fills were covered. I have done all the stuff and already talked to surgeon and just waiting on the phone call for surgery. Good luck to you

Edited July 9, 200818 yr by carolynfletcher
left out a word

My VA doc told me it would show good faith if I tried to lose some weight before going to my bariatric doc consult appointment so I lost 5 lbs of Water weight. My paper work was submitted to Tricare Ins. but it was disapproved. Get this I was disapproved because I didn't weight enough ( I am 211, on the low end of the Met Life table). Anyone have this issue and if so how did you combat it?

Also, Co-Morbids: I am blessed with only have sleep apena and arthritis in my knees. I am getting an MRI next week on my knees so I'll have documentation for that and I have a CPAP machine I use nightly for sleep apena. My question: Looking on the Tricare webiste I couldn't find sleep apena listed as a co-morbid, so where is it listed. Also if it is a co-morbid, is there a degree of sleep apena specified?

I am thinking of doing an appeal, anyone have a good starter letter that would provide me with the basics of what to say?

Thanks for your help and God Bless!

My fills have been covered, except for the $12.00 copay. My Dr. now requires a Barium swallow before a fill, it is NOT covered. He just started it and charges $50.00 for it. Most Dr.s don't do this. I have had 4 or 5 fills, and only the last one was under the new Barium.