Pre-op Newbie - question about TricarePrime acceptance

Hi! I am set to attend my first seminar next week. My Dr. will be Dr. Villares, as there is not one in Tucson who performs R-n-Y and accepts Tricare. I have heard some horror stories about Tricare - that you need to journal all your food intake for a year...must have numerous receipts for weigh****chers, jenny craig, gyms, etc...and that getting accepted is a huge pain in the butt. I am about 150 lbs overweight and have many comorbidities, including acid reflux, (I am pretty sure sleep apnea, though it is not diagnosed yet), arthritis, incontinence and high cholesterol. If you have used Tricare Prime for your surgery, could you please let me know if these stories are true? I want to be prepared for my first doctor's visit and not have any surprises. Thanks! Karen

Karen, I didn't have/use Tricare, BUT there was a lady at the Chandler Support group meeting last week who had them as her insurance carrier, and she had her surgery about 2 months ago with Dr Villares and said her approval was very smooth--- she didn't need any diet history and all that other stuff and she was approved in just a few days. Here's hoping that it works out as smoothly for you too! Good luck!!!!!!!! Darlene

Hi! Thanks for responding to my post. I hope that all those rumors were for the past, and that people get approved easier now. I sure hope so! Thanks again! Karen

I'm another pre-op newbie and haven't posted very much but have been reading other posts for about a month--finally registered on the site. I also have Tricare Prime and had gone to Barix in Scottsdale with Dr. Schlesinger and they told me I was approved with Tricare (which only took about a week--but I am trying to find out how it was approved because I have no paperwork from Tricare). I had all the testing done that the doctor wanted and then last Friday I was expecting them to call to schedule a surgery date. The bad news is that they told me that they cannot do the surgery because Tricare has changed their regulations just recently and will allow only facilities that are "centers of excellence" to perform the surgery and Barix does not qualify because they do not have an ER or ICU. I am still trying to find out what this all means. I researched on this site and found that the only "center of excellence" in the Phoenix area is Scottsdale Shea with Dr. Blackstone et al. When I checked all the doctors against Tricare's provider list, none of them are listed. I asked Tricare how to handle this and they said I could do a POS and pay $300 for out of network provider plus 50% of surgery or get a referral from my PCM. It sounds like if I get a referral from my PCM, they will pay for the surgery so my next step is to go visit with him and then we'll see what happens. When I talked to him several months ago he was not inclined to give me a referral even though my BMI is through the roof. I'm crossing my fingers because I was all psyched up about getting this done and over with and now have to get over this stumbling block. Sorry about the lengthy story--as you can see, I'm not done yet. I do have several co-morbidities so I don't think approval is a problem.

That is valuable info for all Tricare folks to hear. Thanks for the details... I know that St Luke's (Bridges) is now a Center For Excellence and used to take Tricare folks. That was when Dr. Zahn was there though so I'm not sure about now. It might be worth a phone call to find out. (602) 251-8828. Good luck with the process! It's worth the work and the wait! Joyce