Trouble with Tricare/Triwest

Damn Tricare and the horse they rode in on. My "previous" surgeon gave me a surgical date knowing that Tricare was no longer approving Lap RNY only open RNY. The nurse called to kick me in the teeth and tell me that they don't do Open RNY and my surgery was canceled indefinately. I've located a new surgeon that does Open RNY but I hate starting the process all over again. Well, at least, I already have the Psych eval part behind me. I hope the psych will provide the paperwork she did for the first surgeon for the new one. Can someone who has had Tricare/Triwest pay for the open since 01 Oct 2004 give me some input on how they did with the open RNY? Becca

can't help you with any knowledge except to say that tri-west is really something else.. am grateful that my surgery was done Before they made these new rules... and am so happy that our surgeons are not giving in to the Tri-west new rules.. good luck to you hon. Do know folks that have had the open and they are doing great... longer recovery but still doing great.. just do whatever your surgeon tells you to do and all will work out. Do let us know how things go. Best of everything. Hugs, Fran

Thanks, Fran. I won't give up without a fight. I think I'm going to like the new surgeon with his smaller practice and not getting lost in the pack. Will keep everyone posted on how Tricare/triwest treats me for insurance. Just wish that Tallgrass had been quicker in telling me that Tricare wouldn't cover the lap RNY. I just hope I'm not a day late & dollar short again. Becca

Which surgoen are you using??

I'm going to see Dr Tayiem in Atchison on Monday. I've read testimonials by former patients and they are all favorable. Just no recent Tricare patients which is what I need. I talked to someone in KC,KS and they won't do Tricare Open RNY becasue tricare only pays $1300! Can you believe that? That goodness I have a secondary to hopefull pick up the remainder.

Can you please let me know what Tricare does or does not pay for. Also are or were you active duty or do they only pay for dependants.

Jakelia, Not sure just how much they will pay at this point, taking consideration the usual deductibles, co-pays and daily hospital charges for "room & board" ( I think this is about $16 a day) I have a supplementary insurance and it will pay for a lot of the co-pay as long as Tricare gives the surgery it's blessing. Tricare has reversed it's 01 October 2004 decision & is now covering the Lap RNY but I'd went to a surgeon that only does Open and they approved it. I really don't want the open and that authorization expires on 01-22/2005 and then hopefully Tricare will approve the lap authorization submitted by my original surgical group, Tallgrass, in Topeka KS with the surgery at St Francis. Frankly, it would have been much more convenient for the surgery to have been at Atchison Hospital but I like St Francis much better. But I simply can not afford the recover time of an open surgery! I'm a dependent spouse of a retired Army serviceman. Becca, Holton, KS

How are things going for you now?? What decisions have you made? Hopefully you have been able to go to Tall Grass and have a surgery date for the laproscopic ... Tri-West paid for ALL my expenses except for a wee bit of the co-pay for office visits AFTER a time..... paid the hospital $44 and that was it there too.. so wonderful.. terrific... Grateful for this.. Take care now and Happy New Year... this will be a good year for you !! Keep us posted hon. Hugs to you, Fran