I am new to this has anyone have Tricare insurance. How long did it take to get approved?:frown:

Hi Maggie!

Thanks! My liver...my surgeon has me on an atkins-type very severe diet of 2-3 100 cal Protein shakes a day, 64 ounces of Water (at least) and a palm-sized piece of lean chicken turkey or fish, and some green veggies daily. That is it. no butter, no ketchup no breading no oil....you get my drift! I did go nutso and chew a piece of sugar free gum last night but "confessed" it today and they said that was ok! LOL

Tricare standard will cost more than prime depending on how much you use it! We don't pay anything. We get our generic drugs fairly cheap (most are $3 per scrip). We have a $150 deductible we meet (it's just my husband and me, and we each must meet that deductible) and then

Tricare compensates at 80% and we pay 20%. Tricare has a $3000 catastrophic cap so once we've paid 3k out of pocket, tricare reimburses the rest (in any year, of course) at 100%.

Years we had little/no medical issues, tricare standard was cheaper. This year, prime would be cheaper but, as I've said, we don't care for the network doctor's prime restricts us to locally. It's a personal decision of course!

I do feel lucky (for the 1st time!) to have tricare, though, after reading some of the horror stories people here have shared!

JWRN - I am soo sorry about that! Are you going to appeal it? I definately would, tell them they got your height wrong, lol. That should help! Seriously, keep on fighting...you deserve this!

Oh, I WILL weigh the required amount...and maybe 3 lbs over for good measure. It just shocked me when the tricare rep read the denial to me over the phone and said what I needed to weigh to get approved.

You GO Girl!! Dont let them get you down! Try the rolled up coin bit, I didnt think of that one...

How soon can you resubmit it? Does Tricare make you wait any certain amount of time? How long has it been since you first weighed in? I cant believe they are being so petty about 6 lbs!!

JWRN...eat something fatty and disgustingly unhealthy for me, ok?

Good luck. Those turkeys!

Oh, I WILL weigh the required amount...and maybe 3 lbs over for good measure. It just shocked me when the tricare rep read the denial to me over the phone and said what I needed to weigh to get approved.

Hi, just checked online and it was showing a code: ANC and I called and I was told I was denied and since the letter was not generated I have no idea WHY I was denied. I guess I will see if I can appeal or not.

Did you talk to a human? They should tell you why you were denied.

Probably they same reason I was, considering we have about the same stats.

I have this feeling that my approval is too good to be true and they will pull the rug out for some reason! I'm still in shock about it! Good luck you guys definitely fight for it!

Carly, it's none of my business....but I am a curious Monkey...

why so long till your surgery?

Well the city I'm in is the only one in Montana that does LapBand and there are only 3 dr.s here and mine is the most popular! I was pretty surprised too! But there is a chance I might be moved up, I hope!

Thanks for your quick answer. I'd almost be willing to postpone, just to get to live in Montana! LOL Come on down here to Texas; mine was approved 8/5 and surgery scheduled for 8/11!

Karina, are they still saying they don't have all the necessary paperwork? I would appeall as soon as possible. It sounds like Tricare is starting to deny a lot of people. Wish me luck tomorrow. It is a 2 1/2 hour drive each way so I hope I get some good news, but the way it sounds on here I may need more than luck. Karina, keep trying, you will get it in the end.

maggie:thumbup:

I just moved FROM San Antonio to Montana!! HAHAHA! Needless to say I'm happy where I'm at! I have a chance that it might be moved up no biggie time will fly! I have time to get mentally prepare for surgery and get in all my favorite bad for you foods! HAHAHA!

LOL DH and I are moving west in a couple of years. I don't know if we'll make it as far north as Montana, but we will do love it up there!

And you're right; time will fly.

I have Tricare Prime, south region. I went to the seminar at the end of February and had my first appointment with the surgeon in March. I filled out my part of the paperwork (weight loss attempts, etc.) and had my doctor send in my records and FINALLY got the surgeon's office to send in the paperwork to Tricare in late April. Approval was on line in about a week from the time they mailed it. But I needed to lose more than 150 pounds, have diabetes, high blood pressure, high cholesterol and have had two spinal surgeries so I had plenty of comorbidities. Had my pre-op surgeon visit and GOAL class on 6/6 and scheduled surgery for 7/01. I did not have any psych eval, no EGD, just the regular pre-op blood, urine, EKG and chest xray. Started pre-op liquid diet on 6/21 and had lost 24 pounds by 7/01, day of surgery! First check-up was 07/10. First fill was 8/08 and he put 3.5cc in 10cc band. Have lost 43 pounds as of today (8.5 weeks since beginning liquid diet for pre-op). Tricare has been great, no problems. I had to pay the hospital $25 and pay my $12 copay for each office visit. However, my surgeon's office told me that Tricare will NOT pay for fills and I had to prepay for 6 of them ($600) prior to the surgery. So my visit on 8/08 was the first of $100 visits. If anyone can cite "chapter and verse" where I can find indication that Tricare DOES pay for fills, I would love to see it.

Oh, I forgot to mention that I have not had a blood pressure pill or an insulin injection or diabetes pill since the day of my surgery! All under control! :smile2:

Leigh

Dr. Snow / Mobile, Alabama

320 / 296 / 277 / 170

highest / day of surgery / current / goal