Still in Process (warning long vent)

Ok, I have tried to be paitient but the amount of time I have prior to the end of the year is disappearing. Because I work in the accounting field, year end is fast approaching, and this means that If I do not get surgery by the middle of December, I will have to wait until the middle of March . My surgeon's office submitted the paper work on 10/24, I called Tricare on 10/25 to verify the receipt of the paperwork. They said they had the clinicals but not the Request for Authorization form. I then called my surgeon's office and informed the girl who does the insurance of what they said and asked for her to resubmitt the paperwork with one small change. Mark it priority so I could get a response within 72 hours. On 10/27 the web site showed that the paperwork was in process, so I thought cool I should have a response by 11/1 at the latest. Well, on 10/30 I checked the web site and it showed the date changed from 10/27 to 10/30 and in process (WTF!!!). So, I kept waiting and being patient. Well, today 11/6 I am still in process so I got up the nerve and called Tricare at the first chance I got between working on the corporate budgets. I talked with a wonderful woman and explained the whole scenario, she looked in the system and said that yes indeed the paper work shows priority. So she transferred me to the medical management department and I explained the situation again. This time the woman said that oh, this is an inpatient request and you need to talk to another medical management team who deals with these. She gave me a phone number, so I call it and of course it is after 5pm EST so the office was closed. So now I am waiting for the morning to call them. It truly gets disheartening to see all these people get their approvals and surgery dates, and they get them within a day to a week period of time. Every time I check the web site, I have the fear that I will see the word DENIED attached to it. I sort of thought at the beginning of this process is that if your PCM referred you because medically necessary that it was pretty much a given that you would be approved. I to this day have not seen anyone with Tricare being denied (unless I missed that posting).

Wendi.....first of all relax, I KNOW exactly how you feel. The SAME thing happened to me. Even down to the dates changing. I finally got fed up and called. I finally got to the right tricare lady who told me that I was approved. In fact I was approved not even 48 hours after they got the paperwork. Mytricare.com doesn't show approved until they issue you an authorization #. They won't give you an authorization # until AFTER surgery. She also told me if it was denied it would say Denied. Mine STILL says inprocess and my surgery is all scheduled and ready to go. I can totally sympathize how you are feeling. I was checking the site 10-15 times a day like a drug addict looking for a fix. Hopefully you will get to talk to the right person today and get the confirmation that you need. You might even try to call your surgeons insurance rep and see if they have got word yet. Good luck Wendi!

Wendi, If you don't mind my asking, are you more than 100 pounds over with any co-morbidities. or 200% of your recommended weight. I know that Tri-care is very strict on these matters, they do not really look at the BMI. I wish you all the luck in the world maybe you will get the right person today that can help you. WLS was the best decision I have ever made. Best Wishes Leann

yep over 100 lbs, and have min. two comorbidties. See update.

Man I know how you feel. I am in the waiting process also. I am trying not to call Tricare, but it gets harder every day. I wish you the best and I hope you don't have to wait until March.

I sure hope you don't have to wait. What a bummer. Diana