Tricare question?

I am new to all this. So I'll give a bit of an intro. I am a 27 yr old mother of 3. We are stationed in Geremy. I'm 5'11" and 265lbs. I really dont quailfy for the surgery. Because my BMI is only 37.  But because I have some medical problems, I might get the approval.  we've been here for 3 1/2 yrs now. I had my 1st consult on June 11th. I am still waiting for the yay or nay from tricare. Its been 13 days (not including weekends) since I had my visit. I am starting to think that I will not be approved, since its been taking awhile. After all, I have read from most people on here that tricare had taken about 24 hrs to approve them. Have there been anyone on here that tricare has taken longer to approve them? I am getting pretty antsy waiting for the word from them. Any help would really put my mind to ease. PLEASE, let me know your personal experencies.  Thank you in advance -Mary

Hi Mary, I used Tri-Care also..It took about a week to get my approval over the phone but it actually took about three weeks for the Surgeon to get it..I am in Las Vegas so I dont know if it take longer overseas...The good new is the out of pocket expense was min.They paid for the whole surgery plus the hospital expenses..Only had to pay a few Admin.fees..I don't usually come to this site because I have already had my surgery..I usually am on the Main Board..Any questions let me know...Good luck!

If you have a co-morb that Tricare recognizes then you only need to be 100 lbs over your IBW (Tricare uses the Metropolitan Weight Table). For 5'11 your IBW (on the Met table) is 145. So you'd qualify with a co-morb. Otherwise without a co-morb you'd need to be over 200% of your IBW (so 290). Tricare doesn't use BMI for approval. Did your surgeon for sure submit to insurance the day fo the consult? I had my consult on May 2d and my surgeon didn't submit right away (not until June 6th). I'd double check, though you may already have, to make sure. I'd also call Tricare, see if they've recieved the paperwork/request. I'm not sure about overseas, but I've been able to go online in my Tricare account and see what referals/authorizations are there for me. You'll have to registar of course, but it may tell you whether the pre-authorization is pending (my said that for about 24 hours before I got approval). Good luck! I hope you get your answer very soon!!!

they are a bit slow.  But you should be ok.

Oh man, I am right there with you Mary!  I couldn't get my Dr to recommend me while living in Japan for 4 years, and am now working on it since we've moved to CA.  I'm 6'0" and 265 so 35-36 BMI - like you, I'm under the 100 lbs. mark also.  I do, however, have so co-morbids so hope that I can get the approval to go through with Tricare.  Please keep us updated and let us know what happens!

I have Tricare Prime and i have to admit they gave me absolutly no problems getting approved the only problem was that they did not recieve the paper work the first time it was faxed so i called and personally got the number and called my dr's office and gave it to the nurse and i had an approval the next morning and a date that afternoon. I dont know how things work overseas but my best suggestion would be to call tricare and see if they recieved it because if they did it would be listed on the wedsite within 24 hours with most probley a pending next to it. if they got it and they say it is being reviewed all you can do is wait but if they didnt then you need to get the fax number and call back to  your dr's office to see if they faxed it and to what number they faxed it to and ask them to fax it again if it was a number different than the one tricare gives you.

Thank you all for your replies. Im a lil late updating this,sorry about that. I finally got my approval on July 5th. It took almost a month for tricare to get back to me, but they did..I was actually very suprised when I she told me I was approved. I was even more suprised when she gave me my surgery date. Yup! Thats right, I have my surgery on Sept 11th.... So in a little less then 2 months, I start my New Begining.. Ahhhhhhhhhhhh.....  -Mary