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Tricare referral/need advice



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Hi everybody, just started posting on here today and trying to find my way around. I have done all pre op tests required for gastric bypass but have decided on lapband instead. My doctor put my referral in yesterday and I was wondering how long it will take for Tricare to either approve it or not. My sleep study showed that I do have slight sleep apnea and they said losing weight would cure that. Any insight into the Tricare process would be helpful. I need to lose 110 pounds. Thanks in advance for your help. Maggie:rolleyes2:

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Once my surgeons office did send in the referral, it took about an hour to get the approval. You can check it on the Humana-Military.com web page. The doctor's office called me and said they found a problem with my approval code and it was resubmitted, then two hours later she called back and said the second one was approved with the right codes and my banding is schedules for August 12th. AS long as you meet the 100+ pounds with 2 comorbids, or 200% over ideals weight you should have no problems. If Tricare had approved the bypass, you shouldn't have any trouble getting the approval for the band since they both treat the same problem, just different methods. Good Luck,

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Sherry, Thanks for the info. I would have had the RNY at a military hospital but they do not do lapband. Just checked on line and it says approved with a referral number and a doctor to contact for appt. Is it possible that it was approved so fast? Hope to be joining you in August with the lapband. I am going to call the doctor tomorrow to make appt.

Maggie:thumbup:

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Congrats !!! Yes it means that it was approved that quickly. What took so long for mine was that the surgeons office didn't send in the paperwork until three weeks after my inital appointment. If Tri-care is going to approve or disapprove they usually do it as soon as they get the paperwork. I checked that web site everyday until I wal typing my password in my sleep. I only have to have an endo scope and a phsyc eval because that is what the surgeon requires. Let me know when you get a date.

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Sherry, Is the referral approval and ins. approval the same thing????? What will happen once I have my appt. with the surgeon? I know 2 many questions, I'm just very excited......Thanks for all your help. Maggie:thumbup:

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Hello everyone this is my first time on this site. I am planning on having lap band surgery August 5th. I am scared to death, hence the name. I'm afraid I'm going to miss food too much. As of right now the only medical problem I have is a very bad back and hopefully having surgery and losing weight will help.

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Hi Scared, I was going to gastric bypass and finally decided that was to drastic so am going to have the lapband. I'm not nervous yet, but maybe after I get my date. I'm tired of saying I will start my diet on Monday and it never comes so hopefully this is the answer. Good luck on your surgery and a fast recovery. Maggie:rolleyes2:

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Maggie,

The referral is asking the insurance (tri-care) for approval. When that little block on the right has an a (and the words approved pop up) that means that it was approved. So yes if the referral was approved by Tri-Care it means you have insurance approval. I am no expert but that has been my understanding of this whole process.

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Sherry, That is great. I am calling the doctor tomorrow and making an appointment. I have spent the last hour researching him and it is all good. Will let you know when I get my appt. Maggie:rolleyes2:

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Hmmm, when I got my referral and subsequent approval it was only for the visits to the Lap Band Surgeons Office for evaluation. Then they send in all the paperwork to Tricare. Now I wait for the surgery approval which is separate from the approval to go see the LB surgeon. They could still tell me no at this point, even though I've done all that is required by Tricare. Lets hope not!

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Hmmm, when I got my referral and subsequent approval it was only for the visits to the Lap Band Surgeons Office for evaluation. Then they send in all the paperwork to Tricare. Now I wait for the surgery approval which is separate from the approval to go see the LB surgeon. They could still tell me no at this point, even though I've done all that is required by Tricare. Lets hope not!

Same here. The initial referral approval was just for a consult/evaluation by a surgeon. Then you had to get separate approval for the actual procedure.

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That's what I thought that the referral approval was just for the consult. However, I can see how that is confusing for some since why would they even pay for a consult if you don't qualify. Gotta love tricare!

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That's what I thought that the referral approval was just for the consult. However, I can see how that is confusing for some since why would they even pay for a consult if you don't qualify. Gotta love tricare!

You know, that was my initial thought. And I showed up for my initial consult, weighed in and thought I was doomed for denial because I JUST missed the 100 pound cut off, but had a whole mound of co morbids. I wondered the entire time while waiting for them to submit if they deny me for the surgery, why did they approve me to see the surgeon in the first place.

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I was already approved to have the gastric bypass done at a Travis AFB Hospital but felt that it was to invasive. I also have had all pre op tests done at Travis. So, I wonder if that will make a difference. I am calling the doctors office at 8:00am this morning to see how soon I can get an appt. with them. Will let you know. Maggie:rolleyes2:

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