Question:
For those of you with Tricare Prime...

I have heard that if you are approved for the consultation with the bariatric surgeon it is usually pretty easy to get the approval for the surgery. Is this true? Thanks, Kalena    — Kalena B. (posted on October 27, 2003)

October 26, 2003
I have Tri-Care Prime and when I first started my journey I was told that getting your PCP to refer you was the biggest step to getting approved. Once I had my consult with the surgeon my paper work was submitted for approval and it only took about two weeks for it to be approved. Good luck!! =)
   — Kim R.

October 26, 2003
Hi Kalena. I have Tricare Prime as well. I have to say they were very good at all the approvals necessary. The only problem I experienced is that I had to search for a surgeon in my area that accepted TriCare. When I did however, the surgeons office was very experienced with Tricare, and they took care of all the necessary paperwork for me. As long as you meet the requirements for surgery, there should not be a problem for the approval. I had my approval in 2 weeks. Tricare is wonderful insurance. They can be a bit on the nitpicky side, but other than that no problems! Good luck to you & God Bless! :)
   — EHarding

October 26, 2003
I agree the hardest part was getting my referral. While living on base in NC I had to see 5 different doctors before I got one to give me my referral. With the last abse doctor I went in determined to get my referral and although that doctor doesnt believe in the surgery he gave me my referral. Unfortunately, I left NC before I was approved and had to start again. When I moved to CA and was looking for a new PCM , the very first question I asked was whether they had any doctors that were referring for WLS. When I got a positive response that is who I made my appointment with. After that it was smooth sailing. My surgeon submitted and I was approved in 24 hours. Good Luck
   — kaysjourney

October 27, 2003
I have Tricare Prime also, I was approved in less then a week for an out of network doc (wait time was tooo long for Walter Reed Hospital) They approved my consultations no problem but they ended up not paying for them because they said they dont cover obesity related issues...make sure your surgeon codes in more than obesity. But they did pay for the surgery...go figure. Good luck and feel free to email me with any questions :)
   — Vegas_ T.

October 27, 2003
My PCP is a belieer in WLS so getting the referral was no problem. My approval from Tricare was granted in 6 days after the surgeon submitted my information. The biggest problem that I have had with them is getting the billing straightened out. The surgeon's office has taken over that problem. They want specific codes used and if the bills are submitted with different codes, they will not approve them for payment.
   — Char L.

October 27, 2003
HI. NO PROBLEMS WITH TRICARE THEY ARE AWESOME!!! MY PCP ON THE BASE WAS NOT A SUPPORTER OF WLS WHEN I ASKED FOR THE REFERRAL AND I HAD TO GO TO MY PATIENT ADVOCATE ON THE BASE TO EXPLAIN THAT I AM AN ADULT AND WOULD LIKE THE OPPORTUNITY TO EXPLORE WHAT AVENUE MAY BE BEST FOR ME AND AS MY CARE PROVIDER HE NEEDED TO RESPECT THAT DECISION. WHERE ARE YOU LOCATED? GOOD LUCK ANGIE
   — Angie-H

October 27, 2003
I have Tricare Prime also. I had no problems getting a referral from my PCP or getting approved for the surgery. The two biggest problems that I had were the 12 week supervised diet and the long waiting list for Portsmouth Naval Hospital.
   — KittyKatt

October 27, 2003
I too have Tricare Prime and my PCP and plastic surgeon have just submitted request for an authorization for me to have a lower body lift. They approved the WLS so quick. I'm keeping my fingers crossed they do the same for the lower body lift. Just adding my two cents.
   — Vicki S.

October 27, 2003
Had no problem getting my PCP to refer and was not required to do any supervised diet, just meet with the nutritionist. Pre-testing finished in 3 weeks, then waited 5 months for a surgery date due to the war. Now 4 months out, down 77 pounds.
   — Leslie R.

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