Tricare Standard req. for GBS- Virginia Beach area

Hubby asked me not to stay in our area next year and sit on the Portsmouth Naval Hospital waiting list for upwards of 2 years. He asked how hard it would be to get approved through Tricare Standard and what requirements they have. I really have no clue, but I was originally going to use Tidewater Surgical Specialists in Suffolk but chose to stay on the waiting list (thought hubby would take a ship duty). Since hubby really wants us to stay together as a family unit, Im seeing if I have a second option of using Standard and a civilian doctor and have my surgery before the end of the year. That would give me five solid months of post-op living and making sure I know how to properly care for myself (and make sure everytthing is as it should be). Anyone else use Tricare Standard? Was there a 6 month weight loss requirement (like using TOPS or Weigh****chers) like required by PNH? Im mentally prepared for this (been caffeine free for two months now YAY!) so I can handle the shift from a 2 year wait to a 7 month one (if I had to!). Thanks for any suggestions or information!

Hi! I used Standard....SO glad I did. There are several people here you will find that choose to switch because of the long wait with Prime. My dr is in Newport News, and a lot of people from over your way have chosen my Dr....Dr. Clark. He is awesome! I can tell you....there is NO PREAUTH with Standard....no six month waiting, etc. You either meet criteria....or you don't. Any of the Drs that take standard will be willing to tell you how close you are to meeting criteria. I have the requirements somewhere....can't find them right now. You can look it up on the Tricare site, though. I know one of them is being at least 100pounds over or having a certain BMI and comorbidities. It is SO EASY to get approved for standard compared to most insurances. I was shocked and so happy. Like I said...there was no preauth. The dr office will make sure you meet requirements before they touch you. You will be so happy if you switch to standard! I love standard...cause I get to pick all my drs. I am a nurse...so I am kinda funny about that. Good luck on your journey....it is one heck of a ride! I have lost almost 100 pounds now...need to update my profile....but once you lose weight and start LIVING...there are so many other things to do! Take care, Stephanie

Stephanie- Wow! Such a fast response! I was just sitting here talking to hubby about my decision to switch and try out in town when I saw you responded! I stand 4'11.5" and wegh 240 pounds. My BMI is 48.5. I have stress incontinence (embarrassing) and joint and back pain. It sounds like I would be a good candidate. I will check into Dr. Clarke and we will see *****sponds first. HAHA THANK YOU! Anyone else with experiences, I would love to hear from.

You are about the same height as me....which will help...and I was a couple of pounds more than you...at 243. The height thing and BMI alone have you covered...LOL. There is a girl over your way that had the same questions you did at first...Her name is Dana S. on the board. She came over here and used Dr. Clark as well. Tricare Standard is not like other insurances. We are so lucky not to have to jump through all those hoops. But, like I said...they will make sure you meet all requirements (Dr. Clark's office) before they touch you. He may have you do some extra tests for some reason. Sometimes, depending on your history, he wants other clearances...but as far as insurance goes...I think you are ok. Good luck whoever you decide to use... Stephanie

Its so good to hear great things about a local doctor. I will call their office some time tomorrow, after the children I am watching this week leave with their mom. Im especially happy to know they have dealt with Standard before and won't touch me til I get the okay. Our military families have tight budgets and ours is no exception. Hubby took a second job and wants to use the money to cover an extra expenses. This is a relief to me that he supports me in this and is willing to sacrifice to help me get there if I am approved. The more I hear about this Clarke's office the more I'm leaning towards his services! Thank you again, Stephanie.

I found some things that may help you with Tricare. If you look at this link to the exclusions, it tells you under what conditions they WILL pay for obesity surgery. It is listed under Gastric Bypass https://www.hnfs.net/common/exclusions/Exclusions+and+Limitations.htm This next one is a PDF file. Since some of the prior auth requirements have changed in the past few months, Tricare made this handy dandy chart to compare what you had to do before....and now. You have to look at the chart by section...ie....Prime, Standard, etc. You will see that there is a very small section under Tricare Extra/Prime as far as preauths go....and that obesity surgery is NOT ON IT!!!!! As long as you meet the other requirements(as in the other link above), you don't need a preauth. https://www.hnfs.net/NR/rdonlyres/C4C53DE6-C83C-4D9E-B9A8-65D0544B789D/0/PriorAuthChart.pd f Hope this helps!!!! Good Luck! Stephanie

"You will see that there is a very small section under Tricare Extra/Prime as far as preauths go....and that obesity surgery is NOT ON IT!!!!! As long as you meet the other requirements..." Ok...so its late....LOL...Please change the word Prime where is says Extra/Prime....to Extra/Standard. You will see what I mean when you read the chart. Prime has a much larger section of things than does Extra/Standard. Ok...I am going to bed now to recharge...Can't type anymore. LOL Stephanie

Thank you for those links! Reporting in to the wonderful people here-- I just finished up my Tricare paperwork and I am officially a Standard beneficiary. I called the Center at 5pm but they had closed. Will get my seminar date tomorrow! I'm so excited. The Tricare person who did the paperwork told my husband that I should have absolutely no problem with approval. From his lips to God!

You will be SO glad you did not stay on that waiting list! LOL. Your new life will begin so much earlier! I am glad you were able to get it all taken care of. Stephanie

I just realized that you began your journey around this same time a year ago. I keep reading about a computer test and then a psych eval. Is the computer test also a psych eval? I hate computer tests-- I never know the right response to questions where the answers are (Strongly disagree) (Slightly Disagree) (Not Sure) (Slightly Agree) or (Strongly Agree). I actually overthink it and wonder that if I choose Strongly agree or Strongly Disagree to something I'll be considered an extremist and if I choose the Slightly answers, I'm a flake. LOL I especially hate them when they are used for job applications! I'm confused about finding a new provider. I have the listings right here with me. The hospital just up the street from me (Sentara on INdependence) is a facility. Does that mean all their doctors take in Tricare Standard patients? Or should I make things simple and just choose a Family Pracitioner a block further down the road. I got lucky, there are several that are less than 3 miles from me. Say I choose the family practicioner. I go to the meetings with Dr. Clark and they give me the list of labs I need done. I then take this list to my new doctor? And do I transfer my medical records to the new doctors office or do they request them from the hospital (I'm with Boone Clinic). I do know I can request a copy for myself of my entire record and it takes ten days. I might just do that tomorrow. I told you I needed my hand held through this!