PNH wait and Tricare Standard or Prime?
I posted about Portsmouth Naval Hospital and it seems as though I will be in for a long haul. But I was wondering since I went through all of the testing and meetings and things of that nature before would I still have a such a long wait. Is it that they have too many patients or that they take their time and want you to wait? I looked into getting WLS in 2004 and was denied by tricare. I was very upset and decided to try once again on my own to lose the weight. Now here I am 2006 and even bigger then before. I really want to get this surgery but I don't know if I want to wait another two years for it. Explain Tricare Standard to me. Will I still be able to see my regular PCM at the MTF or will I have to go to a civilian provider? Basically is switching to Standard worth it in the long run?
Hi,
I was told that I would lose my PCP at Boone clinic, which is a shame as I just loved her. I also did my tests and stuff before switching over, which I recommend as it cuts down on cost and my surgeon accepted them. Some things can still be done at the MTF's but we are way down the priority list now. You can still get prescriptions there and lab work. Also, after a year on Standard, you can convert back to Prime if you wish. My son and husband are still on Prime. By the way, there is a $1000 cap per year on charges to you if you are active duty dependent and $3000 cap for retiree dependents. THis goes from OCt 1 to Oct 1, fiscal year.
Debbie
Hello,
I don't know if this will give you the answers you're looking for or not but you could try looking at this page from the Tricare Website. You would certainly think you could choose to keep your PCM at your MTF but it would be best to ask before making the switch. I guess my question there would be, "Why would anybody want to?!" The care I receive at my MTF is pretty good but I have yet to see the PCM I'm assigned to and even if I do get an appointment with her, by the time I get there I'm usually seeing a PA instead. That is an unnerving thing to me about military health care....I've lived here 5 years I have yet to see the same person twice...ever...for anything! You mention that you have had testing, meetings, etc. back in 2004. I couldn't swear, but I have a feeling that much of that would be disregarded and would have to be repeated at this point (especially labs and your pap and mammo have to have been within a certain period of time), especially if you use a different facility. If you had the BMI and you've tried all the diets etc. I am surprised that you were denied by Tricare. Surely you have aches and pains in your joints, or maybe problems with sleep apnea. Maybe not....I know if my BMI were down around 40 ish I would be doing a lot better than I am now. Mine is 53. My impression of NMCP is that it's a first come-first served situation....where they reserve the right to scoot serious cases ahead of people. In other words there might only be 10 people ahead of me on the actual list right now who are waiting for their first consultation with the surgeon, but if someone comes in with a situation more lifethreatening than mine, I have no doubt, and complete understanding of the fact that they might be taken ahead of me. I would not want the job of coordinating patients at that or any other WLS facility with such a long wait list. The waiting does give us time to become well educated and I try to look at that as the bright side. I hope this helps. I will be attending the support group at NMCP for the first time this week. I've been trying to get there since last May but this entire process for me has been about re-prioritizing my life, figuring out what things are important for me to keep doing and what I need to let go at this time. The surgery is but one part of that whole picture. I've been an extremely busy person and community oriented but have reached the point in my life where my health needs must come first and I need to focus more on my own little family and what they need for the next few years. So I'm just now at the point where I have freed up Thursday night so that I can go to the meetings....and I"m really looking forward to that. I think.....for me anyway.....this wait I have had will prepare me and give me some patience that I need for myself when I hit a stall. Stalls in weightloss have always been a pitfall because....I want it gone now....no....not now...yesterday. Once this surgery is done I'll have to be very patient with myself...and diligent too...in continuing to repeat everything I've done, do what the doctor says and be conscious of my water and protein...and I think if I can look back to this past year to what will probably be 18 months and say, "Wow....I made it through that to get here....I can wait five or six more weeks for the scale to drop." Best of luck to you in all the decisions you need to make. If by any chance you ever made it to the list for NMCP....you are probably still on there. Call the clinic and ask. It can't hurt. If you are on there they will tell you what your number is and you can go to the website for the clinic and see where the online queue is. Right now it's at 81. Keep us posted on what you do and where you go!!!
OOps! I forgot to give you the link!!! Sorry! This compares Prime and Standard
http://www.tricare.osd.mil/TRICAREStandard/std-compare.cfm
In Auust 2005, I made the personal decision to drop my TriCare Prime for TriCare Standard was the best decision I had made.
I was in WA state when I made the decision to have the surgery. However, I was in the process of transferring to VA and didn't start anything, other than having my PCM document everything about me. I was in her office every other week for 3 months documenting every ache and pain I encountered. She knew, and understood, why I was doing this and supported my decision.
While in WA I found out that the wait at PNH was 18 - 24 months and that they would refuse a non-availability. My only options were to either go onto the list, or go Standard. I chose to go Standard.
I found a doctor who is in the network, researched him and found that he was highly recommended by several on this board (Dr. Clark). I went to his seminar on August 23, 2005.
I had to select a new PCM (civilian), because I could no longer go military (Standard does not allow you to use the military facilities unless it is an emergency). So, I selected a really good physician w/ experience treating WLS patients.
I had my surgery on October 12, 2005 (6 weeks after I went to the seminar), and I feel GREAT!
In fact, I have already decided that I will not be going on Tricare Prime again. Mainly because I want to see a physician who is capable of treating WLS patients, can spend more than 15 minutes w/ the patient and is the only physician I see. I have been very happy with my physician.
Ok, now costs - these are MY costs, and only MY costs. I cannot guarentee that you would pay the same amount, but can give you a little insight:
See my profile for an indication as to what I experienced in costs for the surgery. In my opinion, they were minimal. The key is using network providers. And OH! All of my tests were conducted using TriCare Standard.
Also, the approval process is MUCH easier if your BMI is over 40. You do not need to have comordities. In fact, the day my doctor got the documentation from my military records showing that I had had a thyroid test done in WA, they scheduled my surgery date. Nothing was sent in to TriCare for pre-approval, because TriCare does not require them to do so as long as the patient meets the criteria.
Hope this helps. But, remember, it is a personal decision and you need to this about what is best for you!
Jill
263/206/145
It must just be different areas because i live in richmond va and have tricare prime..we are retirees..anyway at the time of my surgery my pcp was fort lee va we haves since changed to a closer doc for us but my pcp at ft lee gave me the referral in aug and i had my surgery the end of oct...everything was approved within two weeks..good luck
tana
open rny 10/30/2003
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