Tricare prime

Hey everyone! I'm new to this page and not sure how it works so I'm sorry if I do this wrong lol

I'm 22yo, 108lbs overweight (I'm 222lbs), and my BMI is 44.8. I have Tricare prime. My PCM put in a referal to tricare to see if they will cover the surgery or not. I'm nervous and scared they wont approve it. Did you have to call the referral number or will they call you if you are approved?

I do not use that insurance or know anyone who does BUT my surgeons office called me as soon as they got word (about 2 weeks after submitted) and set up my surgery right away. I do know of a couple of people who actually called their insurance to check on it though.

The best way to find out if you are covered or not is to call the number on your insurance card and ask them.

If you are covered and you are denied, you can always appeal the decision.

Best of luck to you!

Sorry, I should have worded it a different way, I meant to see if my insurance will approve the surgery, not cover. They will cover it.

Their approval will depend on what their criteria is, ie: co-morbidities, BMI, supervised diets, psychological testing etc.

Again, the best way to know is to call them.

My understanding from the people at my support group who use Tricare is that there are a number of hoops to jump through for approval - some number of support group meetings, various other appointments, etc.

I'm confused. Have you seen a surgeon yet? Has your information been submitted for approval? Are you trying to find out if Tricare pays for surgery in general, or if Tricare will cover your surgery in your specific situation?

In general, most people find out their insurance requirements (medical records, proof of comorbidities, medically supervised diet), fulfill the obligations and gather paperwork, then the surgeon's insurance coordinator will submit it to insurance. The insurance company makes a decision, which usually takes about two weeks, then tells the insurance coordinator, who then calls you.