I have Questions about TriCare Prime

Anyone out there have TriCare Prime?  I am getting ready to have have my clearance tests ran and am not sure if I need referrals, or who the referrals should come from.  I have my first consultation with the surgeon on Aug. 5.  I waited a month and a half for my referral to see her, then got a letter from TriCare stating I didn't need a referral for that service.  But on the phone they said I did.  Is anyone else running across this and can you help me get maneuver through the TriCare system, Please?

To cover your self, my answer to your question is that everything and anything that needs doing will need a refferal. 

Tricare is very picky and requires you to me a minimum of 100 lbs overweight with a least two comorbidities or 200% over your ideal body weight.  FYI the use the metropolitian weight table....default is medium bone frame for your height.

Information that they will need. Either your surgeon or PCM can submit the referrals.

Complete labs, this will include Thyroid and Hypolori (has to do with ulcers)  your PCM can order these.

Psych eval - you will need a referral for this
Nutrition/Dietician consult - this is not covered under Tricare.....out of pocket cost.
Pulmonologist clearance (may include sleep study) - will need referral for this.

If you live near a MTF, you may be able to get some of it done there with your PCM making the request.

I have tricare prime north region. I had to have a 6 month diet,  cardiac or pulmonary cleaance,  test for sleep apnea,  hplyori, and a battery of ohter blood tests.

I called tricare myself about the diet being required and it was.  this was also confirmed at each surgeons office (I started with one and swiched to another mid diet).

I do  recall being told I didn't need a referral for one doctor but that I did for the other.  its even listed in mytricare site as approved yet the other doesn't show up at all.

tricare is weird but they approve pretty fast.  I was approed only a few days after they got the paperwork.  and here I am....I had surery yesterday.  :)

Did you have surgery yesterday? Are you still in the hospital? Hope your doing well if thats the case .

6month diet requirement must be new...I did not have to do one, and my surgery was just this past december...started the process in august.  I too have Tricare Prime North Region...and I was told referral for everything.  I wonder if this is different since I live near an MTF

Thank  you both for answering my questions.  I was also told ( in May) there was no diet requirement of any kind.  I also have Tricare Prime North Region.   I am going to check with them again tomorrow about that and make sure I get referrals for all testing.  I have been dealing with Tricare for 18 years now, but nothing really this big before.  By the way I live in Columbus, Ohio.  We have only lived near a MTF twice.  I have to admit that was nice.  Thank you both again!

Ok, if you meet the quals, and get the referral from PCM, then Tricare Prime is arguably the easiest insurance to work with. The hiccup is usually with the PCM (my guess is that they required someone to do the 6-month diet because Tricare does not...) I had a similar problem getting a referral for a reproductive endocronologist.. the MTF required 12 months of trying to have a baby even though I was having no freaken period.. Sorry, back on point.

Here are the steps I went through...
Monday June 16 asked Dr. for a referral (which if you are prime is ABSOLUTLY required... if you are  Tricare Standard you just have to make sure they are in-network and pay the $15 or so co-pay)
Friday June 20 - paperwork actually left base referral center to be sent to Tricare (they forgot to put my height and weight so it got kicked back internally and I kept calling daily to make sure they sent it.) If you don't stay on them it will add a week here and there to the process...
Monday June 23 - approved for surgical consult... filled out paperwork and waited for appointment,
July 3 - Saw surgeon, did not require I have psyc eval (neither does Tricare, it is at the surgeons discretion), went to the nutritionist class the same day after appt. I also didn't have to have an h pylori test because he said it was contriversial with all the inhibitors they put you on as to whether or not it matters at all. They submitted my paperwork a week later and Tricare turned it around in 48 hours, approved.
Surgery date August 8th
If you have any more questions feel free to pm me .