Tricare Approval or Denial??

[mmmorgan 0]

Yes, I'm really excited but also nervous at the same time. I have been talking to another girl who is having the surgery with the same doctor on the same day, one hour before me. It's so very surreal!

Less than a week to go. Am I supposed to be preparing myself somehow?

[milwif 0]

Yes, I'm really excited but also nervous at the same time. I have been talking to another girl who is having the surgery with the same doctor on the same day, one hour before me. It's so very surreal!

Less than a week to go. Am I supposed to be preparing myself somehow?

Wow just one week? you got your date quick. I guess just prepare yourself mentally for surgery and for life after and how much it will change. Also some places do a preop diet or want you to lose weight. my surgery is in two weeks so you'll have to let me know how it goes for you

[jenn79co 13]

I thought I was a patient person but this wait is testing me! My Dr.'s office sent everything to tricare last Thursday and here I am still waiting! I sent an email to my insurance advocate and she said she should find out soon. Uhhggggg! I thought for sure I would find out if I was approved or denied for the band by now. :thumbup:

[ruffcat 0]

Congratulations~!!!! That is awesome!!!

[tt1 0]

Ok I admit I haven't read all 16 pages but wanted to see if anyone has any experience similar to mine. I just got my pcm to ref me today and she seemed to think I wouldn't qualify. I am 100 pounds overweight and have had spinal fusion surgery and been dx with arthiritis in my lower back. I do not have diabetes or high blood pressure.

I am so scared I will get turned down. Does anyone know if it is an automatic turn down? It does state severe arthritis but not sure what would classify as severe.

Please someone help I really want this. Thanks

[milwif 0]

Ok I admit I haven't read all 16 pages but wanted to see if anyone has any experience similar to mine. I just got my pcm to ref me today and she seemed to think I wouldn't qualify. I am 100 pounds overweight and have had spinal fusion surgery and been dx with arthiritis in my lower back. I do not have diabetes or high blood pressure.

I am so scared I will get turned down. Does anyone know if it is an automatic turn down? It does state severe arthritis but not sure what would classify as severe.

Please someone help I really want this. Thanks

I think you have a great chance at being approved. Maybe your PCM doesn't believe in WSL. I went to my PCM of 19 years and he refused to even put in a referel to a surgeon, so I dumped him and got myself a more open minded doctor who thought I was a great candidate:smile2:

[tt1 0]

Thanks. Guess I am nervous because I don't have any other problems. I wish they would call already. Lol

[ruffcat 0]

Yeah I hate that when the PCM, tries to tell you what or what not tricare will approve... Although I am diabetic, and 100 pounds overweight... my approval went easily... You know you can call tricare at anytime during this process and find out.. I was told by tricare on the phone I was approved just by calling them... Stay ontop of it, like anything military its hurry up and wait, unless you stay on it!! Good luck.. waiting to hear how you did!

[margie2u 0]

Hi, you wont have any problem. I have arthritis and they said having less weight would be better.Tricare was great. My daughter had the surgery 10/1/08 and I had mine 4/10/09. We didn't have to do a psyche test or classes. Shes lost 74 and Ive lost 27. Hang in there. Too bad you couldn't get it in by Oct 1st. I ended up paying hardly anything since our deductible had been met. Good Luck

[tt1 0]

Oh thank you ladies for your encouraging words. They haven't cqlled yet to sch my first appt and I am going crazy waiting. I feel so much better now though. I wish I could get it before oct 1st but doubt I would be so lucky. I would go tomorrow if they let me. Lol I will keep everyone updated. Wow 27 pounds is great!!

[Jessimond 0]

How do I even start this process? Was told by my PCM that I need to find a surgeon or facility that takes Tricare and they will write a referral for me... Trouble is, I cannot find one in a 100 mile radius and that's the highest search perameter on the Humana site! Tried searching for "bariatric surgeons" and "weightloss surgery" and come up with nothing on Tricare's main site. HELP!!! I'm in Tricare SOUTH - North Central Texas - and willing to travel to the Metroplex if necessary!!!

[Mommie_of_4 0]

How do I even start this process? Was told by my PCM that I need to find a surgeon or facility that takes Tricare and they will write a referral for me... Trouble is, I cannot find one in a 100 mile radius and that's the highest search perameter on the Humana site! Tried searching for "bariatric surgeons" and "weightloss surgery" and come up with nothing on Tricare's main site. HELP!!! I'm in Tricare SOUTH - North Central Texas - and willing to travel to the Metroplex if necessary!!!

Tricare South doesn't list the doctors under bariatric surgeon or weightloss (event though it would be a big help). The bariatric surgeon are listed under 'general surgery' or sometimes 'vascular surgery'. The way I found my doctor is going some of the doctor names on the LapbandTalk website in my area and then searching for the specific doctor's name on the humana-military.com site.

My doctor Dr. Craig A Ferrara, DO is in Fort Worth. The surgery went great and I'm definately pleased with my results. It was VERY quick in getting the entire process completed. I went in Late July 2008 for my initial consultation, office submitted the forms and was approved first part of August. I think it was a total of 8 days until I was approved. Didn't know if I was going to be...but Tricare approved it and the rest is 'weight loss' history.

PM me if you have any additional questions!!

[ruffcat 0]

How do I even start this process? Was told by my PCM that I need to find a surgeon or facility that takes Tricare and they will write a referral for me... Trouble is, I cannot find one in a 100 mile radius and that's the highest search perameter on the Humana site! Tried searching for "bariatric surgeons" and "weightloss surgery" and come up with nothing on Tricare's main site. HELP!!! I'm in Tricare SOUTH - North Central Texas - and willing to travel to the Metroplex if necessary!!!

You shouldnt have to find your own surgeon.. my referral was put in.. and I got a letter in the mail.. with the surgeons name on it and all information... ask your pcm to just put a referral in for a bariatric surgeon.. tricare will inform you of who you will go to :tongue2:

[brat7169 0]

I have Tricare Standard and my Dr. indicated there might be a 6 mth diet waiting period. Has anyone else had to wait six months with Tricare?

[hope2bthinr 0]

I was approved after appealing. Luckily the appeal only took ten days from the day I called the surgeon and got re-eveluated. turns out I was under weight the first "official" weigh in but was over the threshold the second time when re-evaluated. I'm scheduled for next monday!! Oct. 19th! Can't wait!! All my preop testing is complete and I'm cleared for the surgery. Yeay! I'm so happy!! (jumping up and down inside daily until then!)

Oh yeah, brat7169, Tricare Standard does not have a six month or three month or any other supervised diet before clearing you. Either you're authorized or not. It sounds like your Dr may be going by his own requirements or confusing some other insurance with Tricare. Hope this helps.