Tricare Prime

I have searched the boards and have found very little recent information regarding Tricare Prime approvals and procedures.  Anyone recently or currently dealing with Tricare? 
Thanks!

I wish very much that OH would set up separate boards for each of the insurance providers - wouldn't it be nice to go straight to the Tricare Prime board and find everything you need??!!

 

Tricare Prime approved my RNY and I had surgery 11/17. Tricare was really easy to work with,just make sure you get your referrals. For my surgeon's program I had to pay out of pocket for the psych eval and the nutrition education class.Once the bariactric clinic submitted all my paperwork they approved me in 2 days. You just have to meet their criteria,its in the Tricare handbook.

I had surgery in March. I had zero out of pocket expenses, Tricare paid for my psych eval.

I was denied... my surgeon is trying to connect with the Medical Director to have a "peer to peer" call... has not been able to get hold of hime yet.  I put in for a "revision" or "take down" as my body totally rejected the lap band... when it was removed 25 months ago, there was no way I could have rny at that time.. too much swelling internally and my body had created a fistula (tunnel) from my stomach to my left lung because of that band, and that had to heal... completely before anything else could be done.

The reason they denied me was "Did not meet the criteria" but they never quoted the category I was going for.... hence the peer to peer call.  I don't meet the criteria  other wise, they don't think my sleep apnea is severe enough since I am not a breather at night... didn't go on it because we were going for the rny... if the peer to peer doesn't work, then I'll have to get my pumonarist to write me a letter saying that...

Or I might end up going VA... out of pocket cost would be around $1500 (surgeon's office visit $50 each, hospital $1100 for 1st night and $10 each day after that.)

If you are retired, you might want to look into that... if your spouse is active duty there are several military intallations that also do the procedure.

Let me know what happens... I am VERY interested.

Hi,

What do you mean by "doing VA"???   You have to have Tricare Prime here (Bethesda).

I'm retired USN.

Sheri

You can go on line and sign up as a Vet for VA benefits so long as you served active duty and are retired... they have opened up also to those vets from the Veitnam war and of course those from the gulf war, etc.  Those vets that are getting out now that have served in Iraq or Afganistan get free medical for 5 years after they get out so long as their discharge is honorable or general with honorable.

I am signed up for VA ... so I can choose to go with VA here at Loma Linda (S. Cal) or go with TriWest (Tricare Prime)... they don't supplement each other.

With VA I have larger co-pay as I have no medical problems from being in the service... so my co-pay is $15 per dr visit, $50 per specialist visit, and $1100 for 1st night in hospital and $10 each day after.  However, the people at Loma LInda said that payments could be arranged for the hospital stay.

With TriWest, it is $12 per dr/specialist; $25 - $125 for hospital.

Hope this is helpful to you....

Just got my verbal approval for the revision... should have the written approval in the next day or two... then we'll schedule my surgery!  SO EXCITED!

Wonderful, Kathleen!!! Congratulations!!

I'm still lost with the VA thing - is this in a VA facility??? I think I've figured out how to sign up... but not sure it's possible to use this benefit locally (DC area).  When I lived in San Jose, I went to the VA hospital there, but here, everything is Tricare Prime. You can't even be seen with just Tricare - you HAVE to be signed up for Prime. So many retirees in this area..... not enough clinics....

What were the requirements?? Sleep apnea tests? Six months monitored dieting???

Sheri (retired USN)
VSG wannabe!

 I had my surgery done at beaumont in El Paso. My pcm put in the referral to the surgery clinic. From referral to surgery date I think it was like about 8 months and I was "only" 120 lbs over. I also had hypertension during my last pregnancy and gestational diabetes and had high cholesterol and family history of heart attacks. But was other wise "healthy"  I could have been referred out because of the long wait but I really trusted my surgeon and wanted it with him so it took a little longer. You have to make an appt with nutritionist , get psyc eval, attend the support group like 2 times and labs. Then you go on their waiting list....  or request to get referral out. Beaumont was great as far as patient care and answering questions.