tricare - what's not covered with the surgery

I have referral to the surgeon on July 1st and was told by the WLS nurse that Tricare doesn't cover the cost for the nutrionist or the psych eval.  When I asked if I could go ahead in make these appointments since they aren't covered, I was told I had to wait until the July 1st appt.  I'd like to speed this up.   I fit the bill for the metlife table, etc.     Any suggestions on how to bypass some of the buracracy?     

Lisa in Denver CO

My insurance is the same way! I think its rediculous that it doesn't cover the requirements! I just got a bill in the mail from my insurance saying that they don't cover nutritional councling. But im sure it will be worth the bills. :)

Hmmm.  Do you use an MTF?  If so, do they have a psyc dept, and a nutrionist/dietician available?  If so, have PCM write a referral to see them.  I go to an MTF and had my psyc and nut appts done there and then took the notes to the surgeon for submission to Tricare.

I'm SO glad you wrote this ...I am currently at a MTF that does WLS but will be moving soon to one that doesnt..so I am busting my rear to get through their "pathways classes" ( nut, psych evals, ect)  before I move, and was Praying they would "transfer' when I have to deal with Tricare on the civillian sector....*phew!!

Hi Wendy,

No, I don't use a MTF as there isn't a base in Denver.    I really don't mind paying the costs for the NUT and psychologist if I need to, I just need to figure out how to make the appointments now rather than waiting until July 1st to get the surgeon to order it.    The doctors can take forever to get into (i.e. my daughter's neurologist is a 6 month wait (AFTER) she had a seizure.    Since I'm paying for it, I should be able to set the appointment on my schedule, not theirs (IMO).

Lisa in CO 

I had my Psych eval and NUT done at a MTF also. But, when I got the surgeon I had to see their NUT too.  I had to pay the NUT up front and they are putting in a claim in to Tricare. They said that Tricare has been paying for other  patients. So, you might want to have them submit to Tricare, it can't hurt. Also, like the other poster said, maybe if you get your PCM to refer you to Psych.

I have Tricare Prime....I saw the Psych at the MTF....it might be worth your drive to Petterson for a 1 time visit to the psych.  I have to pay for my nut out of pocket but then I can submit my receipts to Tricare for reimbursement...the dr office wont do it.  I never even considered seeing a MTF nut because usually it takes so long to get an appointment.  Good luck
caroline

I have Tricare Prime, they paid for both evaluations. If It was a nurse through the surgeon, I'm going to assume it's because Tricare doesn't re-imburse them as much as they'd like so they tell you that story instead. My surgeons office required me to get my surgey approved before I seen the Psych. and Nut to begin with... which now my authorization for surgery has expired and I need to get it renewed. At any rate, you may have to get your surgery approved first to continue with other pre-op requirements. Good luck.

Good point...never thought about the amount that Tricare pays...I know it usually seems like it is half.  good luck.  keep us posted.

Hi Lisa, have you been to your doctor yet.  Once i went to the doctor on sept 2nd it took 8 weeks to be ready for surgery. were you told that you had to loose any wieght prior to surgery. my doctor required this of me. 25 pounds  talk about a shocker. but if thats what he wanted i was going to do it. he said that it would be best for recovery and he was right. my recovery went smoothly. i had the bypass. we have the better insurance of all the ones that i have read. your psych eval is covered.25 dollar copay  50 dollars for the psych test then another 25dollar copay for follow up test results. the only doctor that i had to push was my pcp. office was alittle slow getting the required letter to the surgeon.  this was the best decision of my life. i am down 55% body fat. i did lose a little hair not that anyone could tell except me and my hairdresser. there isnt anyway to bypass the bueracracy.  the nutritionist appt shouldnt be done until right befor the surgery. they went over alot of post op care. i saw the nutritionist and the surgeons nurse and they went over the surgery and after care etc. i hope that you do well on this journey and remember that you are in control and it feels pretty darn good.    Lisa

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