how tp get approved with tricare prime

 Im glad to heard about your out come.   my pcp gave me  a referral but it was denied. i guess she didnt say all the right things your pcp did...

I have Tricare-Prime as well.  The first step is visiting your PCM and getting a referral.  Once your PCM gives you the referral the ball will start to roll.  Do you live near a base?  If you go to the bariatric department on base it moves faster.  However, I fell in a catch 22 my hospital is merging with another hospital and bariatric surgery has no priority.  We switched surgeons 3 times in 6 months and there were times when the surgeon was not performing surgery because they could not get the operating room.  If you go to a civilian surgeon you will need to see a nutritionist for 6 months.  Try to get started right away because if you go by March 31st, they will consider March your first month and that will reduce your time to 5 months.  The one positive aspect of getting surgery on base is each base is different and they may not require the 6 month nutrition classes.  The biggest negative was that I lived one hour and a half from the base and had to go back and forth for every doctor's appointment and every test.  With the civilian I did every test over in one morning---less than 2 hours.  What a waste of money (double testing, gas) and time.  Good luck and schedule that visit with your PCM right away.  If there is anything else that I can help you with please let me know. 

 I live about 5 miles away from bass. I had a referral from my pcm, but it was denied.... 

Good morning, I am sorry I assumed you were over 100 lbs. and had a comorbidity.  Are you 100 lbs. over the recommended weight for your height?  Do you have a comorbidity such as high blood pressure, diabetes, sleep apnea something like that (the list is on the Tri-Care website)?  Do you snore?  If you snore get your doctor to order a sleep apnea study, which may prove that you have sleep apnea.  That with being 100 lbs. overweight would qualify you for surgery. 

As far as the denial, you have 30 days to appeal.  Have you received the denial letter?  If so, it states why you were denied.  Can you disprove the reason for denial?  If so, contact your doctor and have him/her write a letter stating why surgery may benefit you.  Also, you may want to contact your Tri-Care advocate.  Good luck to you. 

 i didnt get a latter in the mail but i called the referral office and the lady said they denied me and i lefted if as that..... tomorrow im going to call the office back... 

I have been reading about the Tricare approval process and was relieved to see you had stated sleep apnea qualified with Tricare as a co morbidity. I have looked on their web site and have talked to reps on the phone and none of them would tell me definitively that it was. :) Getting ready to have my surgeons visit and then my paperwork will be submitted for approval. Hopefully it will be approved and I will have my surgery in mid to late Sept.

What region are you in? I've heard Tricare's requirements are different in each region. I was just approved for the band through Tricare Prime last Thursday. I have no co-morbidities. Just 100lbs overweight. I did not have to do a 6 month doctor supervised diet or anything. I had to have a psych eval, a gallbladder ultrasound, a EGD, go to the seminar that the surgeon gives and get a letter from my PCM. That was all the surgeon required from me at my first appointment with her. I did all that. Would have been done within a month and a half of seeing her, but I had to postpone my EGD due to my husband's work schedule. (oh and my surgeon got married, so that knocked the month of October out..lol) So I had everything done mid December and then with the holiday's, nothing was happening until the new year. My doctor sent everything to insurance and they came back with needing a thyroid test (which I had done back in August so that was an easy thing to get taken care of, just a matter of faxing the results) and I also needed cardiac OR pulmonary clearance. I found this info out 1 day before I left for a cruise to the Bahamas. lol! So I had to wait a week to get that taken care of. I called as soon as I got back, got an appointment with my PCM and got in a week after that and January 31st I got an EKG. Well, my PCM waited almost 4 weeks to fax that over to my surgeon even though I discussed with her about how I've been delayed on getting this all taken care of so I can actually get the surgery due to my surgeon getting married (which I totally don't mind that, I was busy doing other things required in October anyway) and then having to postpone the EGD a month and then the holiday's. But yeah, then I was postponed another month cause she never faxed the results. But finally they faxed it, the surgeon got it last Monday and Thursday I was approved.

Definitely appeal the decision. You should get a letter in the mail of their decision and it will have all the appeal info in it.

 i live in the north region..... i had a appt. with my pcm for a band referral, i had blood work done thats all. whats a egd? 

 my pcm gave my the referral and she told me to go the the referral office so i went and the aldy said ill call you in three day and if you dont hear from me from the to call her. I called her because i didnt hear from her and she said i was denied for the lapband .

An EGD is when they put a scope down your throat and check out your stomach and such.

I am in the North Region too. And everything went pretty fast once they had everything they needed.

Are you having trouble getting the referral to a surgeon? I think I'm confused in understanding what Tricare is denying for you. I'm going to re-read your posts, but if I read them correctly you have just gone to the PCM for a referral to see a surgeon right? Cause it seems kinda weird that they would deny that. They usually always approve the referral to see a specialist. It's usually once the specialist submits for approval that there are insurance hick-ups.