Newbie with LOTS of questions

Hi Everyone, I have been thinking about WLS for over 2 years now. I guess fear has been holding me back but no longer will I allow it. My dh is retired AF and we are moving to ND next month. I am wantong to get the ball rolling. Can I go to my PCM and ask for the referral or do I have to go to a base doc? We have Tricare Prime. Also, Tricare doesn't pay for Lap Band..... Right? Thanks for any and all help! Bobby

My husband is also retired Air Force. That is how I got started I went to my PCM and asked for a referral to see a WLS Surgeon. It was approved right away. I then had my Psych eval which Tri-Care does not cover. Ihad to attend a seminar before I could see the surgeon. I went to the surgeon on the 20th of this month and they submitted my paperwork Tuesday morning and I had approval by last night. I want to wish you luck on your journey. Leann

Tri Care covered my Psych Eval and Follow ups for any time I want without a second thought. Dont know why yours didn't, that's rather strange Krissy

My DH is retired Army. We have a civilian PCM with Tricare Prime. With Prime everthing has to go through your PCM. You have to have a network provider. We have had no problems with the system. My consultaion was approved overnight. I now have a Tricare nurse for my asthma. She calls me monthly. She is really excited for me to have surgery. She said that Tricare will no longer pay for Lapband. They prefer the gastric bypass and that's what they cover. Wecome to the board, lots of good support here. Diana

Yes, like the others have said, the first step it to get a referal to an in-network surgeon. But I'd make sure you know the surgeon you'd like to go to before you see your PCM. My PCM (civilian) did the referal, but didn't specify my surgeon (Dr. Read), so Tricare just assigned me a general surgeon, who didn't even do WLS. (Weird Tricare). It wasn't that big of a deal though, I just called up Tricare and they changed the referal to my surgeon. Oh, and on what another poster said, Tricare does cover the Psych eval. They covered mine. I just made sure I picked an in-network psych doc (my surgeon's office gave me a list of 5 psych docs they use). Also, you don't need a referal for your first appointment with the Psych doc, but if you see them more then once (my Psych doc did the eval in two visits), the Psych doc will need to do a referal for the extra visits (you don't have to go through your PCM for that). HTH and Good luck!! Andi

Welcome

After being denied about 4 times (network providers). I turned to an MTF and an evaluation for the lap band proceedure was offered to me. However, I would rather have the full surgery. My re-evaluation will be on monday for the full surgery. Good luck to you! (I am the only one who seems to be haveing problems being approved so im sure you will have better luck then i have) My PCM said that the most probable reason for all those denials is that the right proceedure was not used when sumbitting the request for surgery. Apparently tricare likes things done "a certain way."

Looks like you have gotten some great feedback. Just wanted to say hi and WELCOME!!!!

I am also a newbie with alot of questions. Just reading your post and comments helped me out too. I am waiting to go to my educational class. Then I can go from there. I hope I don't have any problems getting mine approved through Tricare. good luck to you.