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Tricare Prime??



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I have Tricare Prime and I was wondering if anyone who has the same insurance can tell me about the approval process with the. I just had my first referal appointment today with my Primary. :grouphug:

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I also have Tricare Prime (West) and my timeline is as follows:

February 21st, referral from PCP

March 4th, consult with surgeon at surgical center

March 10th, approval from Tricare

April 11th, pre-op bloodwork, EKG, chest x-ray

April 18th, surgery

Highest weight was 319, current is 229, goal is 160

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Hi there! I am having Surgery on Monday the 27th at Balboa! The process happened so fast for me! I went in to see my PCM the 2nd week of Aug and got my Referal to General Surgery to talk to them on 19 Aug! Saw them and they told me I qualified health wise and gave me a list of things to complete and then I could come back to them and schedule the surgery date. I had to lose 10 lbs and see the Pyscologist and the nutritionist and have blood work and an EKG. I had everything done by Oct 3rd and they set the date for the 27th of Oct. I did not have to wait for an approval from Tricare or anything like that! Dr. Petterson is doing my surgery and he is awesome! He is a big surfer! Let me know if I can be of any help to you! I am looking for a LB buddy her in the area!!! Hugs

Heather

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Thank you. I am glad to meet someone on here that will be having it at the same place. I am really anxious to get the process started. My BMI is 43. I just hope through everything I get approved. My husband used to work at Balboa. How was the psycological evaluation? What was the reason for loosing 10 pounds? Did you have to do group meetings. Sorry for all of the questions. LOL I have a new San Diego:thumbup: Lap Band buddy.

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Thank you. I am glad to meet someone on here that will be having it at the same place. I am really anxious to get the process started. My BMI is 43. I just hope through everything I get approved. My husband used to work at Balboa. How was the psycological evaluation? What was the reason for loosing 10 pounds? Did you have to do group meetings. Sorry for all of the questions. LOL I have a new San Diego:thumbup: Lap Band buddy.

Yay for new buddies!!! The Psycological appt was fine. It lasted about 30 mins or so and he just asked about my diet history and family past. Nothing hard!!! The Docs at Balboa want you to lose 10 percent before your surgery! My weight was 198.8 at my consult with General Surgery so they told me to lose 10. I am down to 187 right now! I am only 5 foot 1 so every pound is shown on me!! lol My BMI is 36 or 37 now. I have Hight Blood Presure so I was approved right away by the doc! I hope everything is easy for you! Just a little hint...try to get your appt with the Nutrisionist asap. She is booked up and she is the only one that does the Bariactric appts. Get on the waiting list also in case someone cancels. The is how I got my stuff done so fast. My original date to get in and see her was Oct 15th and she had a cancellation in Sept for the next day and I was able to go! Other wise I would not be doing my Surgery till Dec or Jan. I don't mind questions so ask away!!!!

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I think you have to have your consult with General Surgery first but you can always call them and ask if you can go ahead and book it! I can't hurt!!!

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hi i have tricare prime and i started my process in feb and got banded on july 3rd i originally got denied for the surgery but i did an appeal and it got turned around and i got approved once i got approved i was banded two weeks later.

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    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
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    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
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    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
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