Tricare Standard req. for GBS- Virginia Beach area

The computer test is a very brief assessment that is done in Dr. Clark's office before you see the shrink.(usually Dr. Reese, but not always) Dr. Clark will give you a list of the psychos that will take standard and you can choose who can get you in first for an appt. Dr. Reese is awesome and it is very relaxed with her. She is popular, so you may have to wait if you want her. You don't HAVE to use her...just pick someone on the list. Ok...you will need to find you a new family dr. Base rules don't apply anymore...THANK GOODNESS!!!! YOU CAN PICK YOUR OWN!!!!! Your ID card is your insurance card. On the Tricare site, they have a standard directory, but it is not always update...I have found this out the hard way. Best way to do this....get some word of mouth referrals on a good PCP, and call and ask if they take Tricare Standard. Make sure you say Standard....because many will cringe when they hear Tricare, and Standard is all they take. There should be plenty in VA Bch. What happens is Dr. C's office will mail you a package of papers to fill out all about your med history. You bring it to the seminar. They take a pic, weigh you...and then after the seminar over the next couple of days...the dr will look at the chart to see if you meet and what he requires. If you need other things for medical clearance before surgery, they will tell you...and if it is a test....you can get it on the base to save money if they have a spot (if it is something like a scan or something). I know that Labcorp is a Tricare standard provider and I use them cause i don't like being poked all the time for nothing and they are good. There are lots of offices around for them. The good thing about standard is that you don't have to run all the labs, tests, etc by your PCP to make sure it is ok. You don't need referrals anymore since you have standard. You can go to a specialist if you need to and don't have to tell your new PCP...LOL...but I would not recommend doing that. You do need to find a PCP so you will have a family dr of sorts. Let me know if you have any more questions...I think I answered most of them...LOL Stephanie

Oh...and on that paperwork the office gives you....write every thing...no matter how small you think it might be. They use all of that stuff and add it all up to make you qualify for the insurance company. Write everything!!!!!

we are retired and i have tricare prime i was approved within two weeks saw my primary care in aug saw the surgeon twice in sept once for consult and once for further discussio after he received all the paperwork from my pcp ...i had my surgery in oct of that same year...no requirements because of the numerous comorbidities i had all i did was write a letter to tricare outlining all the programs i had been on in the last ten years..it was easy as falling off a log of course that was oct of 03 and things may have changed since then back then they were only approving open rny to my knowledge tana 232/137/150 leveled out nicely

Tana- thanks so much for taking the time to respond! I was blessed with a pcm that looked at my background and saw I've been morbidly obese for over 12 years and was willing to listen to my concerns. No lectures, no admonishment... she also felt I should look into WLS and immediately gave me the referrel to PNH. I am forever in her debt, even if I am not approved. It was so good to have a doctor listen to me. I am healthy, aside from the stress incontinence and joint and back pain. The problem is that diabetes, heart disease, and cancer are prevelant in my family and I don't want to wait until I've actually developed a life altering condition, ya know? I'm only 35, I have so many years left in me! Where did you have your surgey done? Would you recommend them to anyone else? I'll make sure to take time tomorrow afternoon to read your profile!

Hi I am also a Tricare Standard for the surgery. When I called down to Portsmouth the gal that I talked to suggested I switch from Prim to standard. so I did. That was in Oct of last year. I went to the meeting at Dr. Terricina and Clark office and by Jan. 31 2006 I was under the scope. I had Laperscopic By- Pass from Dr. Terricina. I ended up paying 27 dollors to the hospital. I was 236 and a diabetic. Now 3 1/2 months later I am 181 and not a diabetic. Best thing I could have done for myself. And I thank Dr. T. everyday for giving me my life. He is wonderful!!!!! I was only in the hospital for 2 days and didn't need any of my pain meds by the 3rd day. I'm so happy I didn't get the open By Pass but if Tricare would have said no to the Laperscopic I would have done the open. Good luck and I hope everything works out for you. If you really want this than My suggestion would be to contact Dr. T. and Clarks office and find out what Standard needs from you to get the surgery. And just switch. Good luck and keep us posted on what you decided to do... Oh Tricare will do it for medical reasons. And there is no 6 month weight loss required. I did have to show that I have been over weight for 5 years and that I had diabetes for 5 years. There are other reasons they would do it but it would have to be medical. You would have to check what the requirments are. Ellie

I appreciate you taking your time to fill me in on your experience with Standard and Clark's office! I also agree that if Tricare says no to Lap I would opt for open. As long as they say YES, I'll go along with whatever procedure they feel is necessary. Ya know what...since this is the 3rd reference to Clarke's office I've received so far (I got an email earlier), I think I will follow your siggestion and contact them. I live next to Little Creek and Newport News really isn't that far from me. About the same distance as the Suffolk office I contacted. Thank you ladies for making me feel less anxious about this. You know how it is when you are first starting out. Knowing I will be required to stay Standard for 18 months after switching, I'm really hoping it will end up being worth it! I was unable to find the information on the Tricare website. Im thinking I must not be looking at the right one or doing the search wrong or something. I can call them sometime in the next few days to ask questions. I'm watching two kids and have my own 11 month old crawling all over the place as well. Will be tricky to find quiet time. Hmm..maybe nap time! THANK YOU! I'd like to hear more stories if anyone else has experiences!

Hi Ellie! I have seen you when I was lurking on our surgeon's message board...LOL. I don't post much there, cause most of the people I know don't post much if at all anymore. But, when you see Jodi or Kimmee talking about Stephanie....well it is me. LOL I have watched your progress on the board and I am glad to see you doing so well! Take Care! Stephanie

Stephanie- thanks so much for the links. I just called Dr. Clark's office and explained my situation. The lady who answered the phone said my BMI is high enough that I require no co-morbidities. She did say I must switch to Standard before they set me up with the seminar. She said it should take less than 3 weeks for me to attend one once I call back! Im really excited now and I am calling Tricare today. If these kids give me a chance to do so. hahaha!

Hi There........ Tricare Standard, here. It was the BEST decision I made (switching from Prime to Standard). In order to keep the costs down, you need to see a "network provider". Call tricare, and they can give you a list. My doctor was on that list, and I knew that up front (selected him before I switched). They require that you have a BMI of 40 (ans no co-moridities). But, if your BMI is under 40, you need to have documented proof of 2 co-mordities. I had both, so that was easy. You do not have to have 6 month diet requirement for the insurance, but the doctor liked to see my efforts. I went back 5 years. You have to have a thyroid test and a psy eval. Once all of that was completed, I was approved on the spot. With my doctor (not sure if all), but if you met the requirements, there was no need to send in for approval. Tricare paid, based on the doc's assessment compared to Tricare's requirements. I had less than $300.00 out of pocket expenses ($150.00 of that was my deductible) plus the doc's program fess (not covered by insurance) and went to the seminar Aug 23rd and had surgery Oct 12th. I haven't looked back since. I HIGHLY recommend it to anyone. It's been a VERY easy process and I didn't have to sit on a waiting list for 2 years while my body got worse. Now, there are some who have remained Prime and go the non-availability from portsmouth. I'm not sure how long they waited or how they did it, but my experience with Standard has been extremely good. Jill 263/175/145

Jill- Were you over 40 BMI with no co-morbidities? I'm a BMI of 48.6 with stress incontinence and joint/back pain. My husband said he will try to go by the Tricare office at the clinic today and ask some questions. He wants me to switch and I am totally for it. When you get a list of providers, do you call their office and ask if they are taking more Tricare patients? Or after switching can you just call their office for an appointment to start the tests? I feel like having someone show up and hold my hand through the process. LOL. Im so needy.