Can anyone who is Tri-Care prime members post your knowledge and experience of having surgery done by a civilian doctor and facility and those who have had surgery done at a military hospital facility. I am in the plannning stages now and would like to compare my options. Also my husband is retiring in March and was curious to know how my benefits would be affected financially with Tri-Care prime.

LOL,

Kim

I am tricare prime and I had my surgery at a civilian facility in Jacksonville, FL last sept. I got a referal from my pcm and just went from there. Everything was covered 100%, even the labs and the chest xray. I have lost 40 pounds so far. Also, at the doctor's office I was sent to, once the program has been paid for, you are covered with them for life. I will not have to pay for any fills or follow ups with them ever. Now, when my husband transfers, I will have to go to tricare again and get another referal for follow up care at another facility. Good luck with your decision and I hope this has helped. Christy

I'm tricare standard. I had it done at a civilian hospital (center of excellence...) and had a marvelous experience.

I am retired from the Navy and we use Tricare Prime. Last spring I went to my PCM at Ft Eustis to discuss a referral for a civilian doctor to do my lapband surgery. At that time my PCM told me about Portsmouth Naval Hospital now doing the lapband surgery. She gave me a referral to go to Portsmouth and am now waiting for my surgery to be performed in late February. The lead up to the surgery has been about 9 months. At the initial seminar they tell you that the wait time is 9-12 mos. So far everyone there at PNH has been great. My surgery got delayed from January to late February because my doctor got deployed and i had to chose a new doctor. Needless to say I am very excited to have my surgery date finally arrive and be able to move forward to a healthier me!!

My wife and I are both with prime. My wife's dietitian appointment was denied ATT but I have questioned Tricare as to why but they have not returned any comments yet and my claim just was submitted so we are waiting to see how they respond to my claim. My wife's psychiatric has been completed and mine is on 5 Jan and we are waiting to see how they respond to them as well. I have e-mailed tricare and informed them that these appt. are all related to an approved referral with the surgeon.

thanks so much for the info. I too am assigned to Ft. Eustis and have a referral to Portsmouth NH. I heard that the waiting list was pretty long. I am scheduled to do thier orientation this week. I have also done orientation with the weight loss surgery center in newport news. I am hoping the wait isnt as long. At any rate, I will take the time that I need to meditate and prepare for my new life. Blessings to you as it sounds like you are a bit ahead. Thanks again.

thanks so much for the info. I too am assigned to Ft. Eustis and have a referral to Portsmouth NH. I heard that the waiting list was pretty long. I am scheduled to do thier orientation this week. I have also done orientation with the weight loss surgery center in newport news. I am hoping the wait isnt as long. At any rate, I will take the time that I need to meditate and prepare for my new life. Blessings to you as it sounds like you are a bit ahead. Thanks again.

Hello

Yes the wait time is a bit longer at PNH but that has given me the time for my consults with the nutritionists there at Ft Eustis (6 months documented appts) and getting all the other necessary appts to get to this point. The Pysch eval was done at Portsmouth and final appt with nutrtionist there at Portsmouth as well. Lab work was done at Ft Eustis. I checked into the WLSC after they were recommended by other patients that I personally know. They seem to have a great track record. I tried to have my PCM give me a referral but she told me that Portsmouth was now doing the LB surgery. Since PNH sounds like their schedule is pretty full these days Tricare may very well refer you to WLSC and you may get it done quickly - cool! I wish you all the best and drop me a line if you have any questions.

My surgery date is Feb 25!!!

Blessings to you as well....

I have an orientation appointment in a few weeks. I have to admit I am a bit disappointed to learn there is nearly a year long wait :biggrin:

I had mine done at Blanchfield Army Community Hospital at Fort Campbell. Awesome surgeons, awesome pre-surgery program, awesome post-surgery program & support! I was sort of nervous about having it done there and wanted to go offpost, but now I'm glad I had it done on post! Good luck with everything!

I'm scheduled with a civilian surgeon and am covered by Tricare Prime. My BMI is 41% and I'm hoping that Tricare will cover me. So far my pre op has been covered (except the nutritionist). Has anyone been denied?

I would be very interested to know of anyones experience with lap band surgery at William Beaumont AMC?

Hey,

Its nice to know there are some other military wives out there :confused:, I cant really answer your question but have another question for you, how exactly did you qualify, I went to the dr 1 time so far, they said I did not weight enough even though im almost at a 40 BMI, but another soldier told my husband that his wife wasnt heavy enough, but diabetes ran in her family (she didnt have diabetes), so they did it as a precaution, does this sound right, maybe you have some answers? THANKS

Talk to your Tricare specialist. They will have all the answers. I've heard BMI over 40, over 100 pounds with co-morbidities, over 200 with no co-morbidities, etc.

I'm scheduled with a civilian surgeon and am covered by Tricare Prime. My BMI is 41% and I'm hoping that Tricare will cover me. So far my pre op has been covered (except the nutritionist). Has anyone been denied?

I have tricare prime and have been approved for a non network doctor in Miami. My Bmi is only 39, however, I have HBP. My surgeon told me that if you have a BMI of 40 you usually qualify and if it is 35-39 with HBP, sleep Apnea or Diabetes then you will qualify usually. I had no problem getting approved although it is a pain, due to tricare messing up and sending me to the wrong doctors and such. But it took me less than two months to get everything done. AND tricare will not pay for a nutritionist (typically) unless you are a new onset diabetic patient. I got my psych eval paid through military onesource. GOOD LUCK!:confused:

I rather liked my "mess up." The hospital billed Tricare with my social instead of my husband's (even after I told them to use his). Got a $2000 bill from hospital Friday. Had to call billing and hope they correct it..soon!