New Sorta

Hi everyone my name is Missy and i'm still in the early stages of wanting to have the surgery. (My sister had it over 2 yrs ago and has kept it off.) I've got my first appt with my dr on Monday. And now I have some questions, how many of you on here have dealt with Tri-Care? My DH is active duty so that is my insurance. Also once you got the ball rolling with drs and how long did it take after Tri-Care approved you before you were able to have your surgery? Any info will be greatly appreciated!!!! Thank you Missy

Hi Missy I have tricare standard. I had my surgery March 13. I took about 3 days after the drs offiice faxed it to get my approval letter. I haven't gotten any bills yet but I am sure they are coming. Good Luck Jenn

Hi Jenn thanks for the info, how long after your approval was it before you had the surgery? I see you aren't too out, how r u feeling?? Thanks again Missy

Hi Missy.... TriCare here, too. Here's the thing. Do you have Tricare Standard or Tricare Prime. It makes a difference. If you have TriCare Prime, your PCM will refer you to Portsmouth Naval Hospital. They will put you on their waiting list to do your nutrition classes and surgery there. The waiting list is 18 - 24 months long. From what I hear, they have a very good program, it's just long to wait. If you have TriCare Standard, you will select a doctor who is a network provider and will see him/her. They will evaluate your file to see if you meet Tricare's criteria. If you do, approval is done that moment. It took about 2 hours after I obtained the last document from my medical record and provided it to my doctor's office. But, it could take a few days it just depends on how backed up your doctor's office is. But, the key is that Tricare has told the doctor's offices that if the patient meets the criteria, there is no pre-approval required. The doctor will then schedule your appointments and surgery. My timelines were: August 23rd (I think) I went to my Doc's seminar. Sept 20th (I think) I completed everything and was scheduled for surgery. Oct 12th Surgery date. For more accuracy, see my profile. Also, because I went to a network provider, my out of pocket costs were about $300.00 plus the program fee (which ranges from $395 - $750). So, as far as I was concerned it was worth going TriCare Standard and avoiding the wait at PNH. Hope this helps and good luck! Jill 263/186/145

Well that is not the news I was hoping for but it's understandable about the wait. I've got Tri-Care Prime and my DH doesn't want to change it. I guess all I can do is see what happens Monday when I see my PCM. Thanks Jill. Missy

Hi I had my surgery one month after my approval. You can change to standard without changing the rest of your family. Depending on his rank you may have to stay standard for a year. I am doing great I had it done lapRNY by Dr Moore. I was out of the hospital in 2.5 days. I see you are in Hampton too if you want you can email me. Jenn

What out of pocket expenses did you have with Standard? My appt with my PCM is Monday so I guess I find out from there what happens. Would I be able to switch back to Prime after the surgery? Thanks, you can email me off the board at [email protected]. Missy

You will probably have to wait 1 year to switch back to Prime. I did my switch during a transfer so I can switch back at any time. However, I may just stay Standard as I really like my doctor and being able to get an appointment when I need it. Also, I am Standard, but my son is Prime. it did not affect him at all. The key is selecting an in-network provider. Look at my profile, and you will see what my out-of-pocket expenses were. They were right about $300.00, plus the doctor's comprehensive package (He had 2 - one was $395 and the other was $725. I got the $725 cause I got a lot more with it and felt that I would want it). Insurance does not cover the comprehensive packages. But, for me, the choice was to either pay the money to save my life, or to wait and watch myself deteriorate. I chose to save my life,a nd I thank God evey day for giving me the strenght the have this surgery. Because if I had to wait 18 months, there is no telling how much I would have weighed or what excuses I would have come up with. On the day of my surgery, my feet/ankles/hips hurt so bad that I hated to walk. Today???? They don't hurt at all, I walk 2 miles 4-5 times a week, plus bike ride, got to Bush Gardens and Kind's Dominion and just made reservations for whitewater rafting with my guys. Big change since last year. Good luck to you Jill 263/186/145

Hi Missy...welcome to the best board! It is an amazing place with so many freinds! Your gonna love it. I don't know about your insurance but just wanted to say hi and welcome... Hugs, Betsy