Going civilian and Steven's TriWest question

Just when I think I know what Madigan's policy is, the change it. My neighbor has been talking to me about surgery since right after mine. She has played with the idea and been through the emotions. I know she reads the boards, so maybe she will speak up when she sees I am talking about her. Anyway, she got the info from me and I printed out my profile for her. She only gets on the net at the library. Anyway, two weeks ago she decided to start the process. She got a referal to Madigan. Instead of making her go to the orientation, TriWest gave her an appointment with a surgeon. She had her appointment on Tuesday. I forget his name, but he was a complete dork. He told her she didn't need to go to the orientation, didn't need to see the nurtritionist and didn't need any other appointments. He put her right on the list. He said she was on the 9 month list and call list. He also said that all of her body complaints weren't enough to qualify her. The only reason she qualified was her early diabetes (sp?) diagnosis. So, she told him she wanted to go civilian. He said fine. Go see her TriWest rep. He would sign her request to go civilian as soon as he saw it. She made an appointment today and had the referal printed out when she left the appointment. It is amazing how some people have such a hard time getting away from Madigan and others slide right out with no problem. I am happy for her. But, I wish that it was that easy for everyone that wants to go civilian. I have a question. Isn't Stevens in TriWest's network? TriWest told me no. But, I really think it is. Hat

gee, i wonder if she had my dr. lol was it dr. watts?? lol

Steven's Hospital does the Tri-west for the sugery for Dr.Weber I know that for sure because that is where I did my orientation. And when I had my first appointment with him he gave me the choice of two hospitals and that was one of them.

Yeah, they do cover Stevens....I had my surgery at Stevens... Is that what you're asking?

Well, I knew that was one of the options. I did my surgery at Ballard because I am from Tacoma. But, just because he is in Tricare's network, doesn't mean that every hospital he operates at is in the network. Since he offered me either hospital, then I assumed that both were in the network. This would be an important item to know before running up a bill thinking that TriWest was going to pay for all of it. OK so I was assuming that Steven's was in the network. So, when I was sent to Steven's to take care of my stricture, I didn't even think to ask if they were. I was told if it was an emergency, then to just go. A couple of days later when I was talking to the TriWest rep, she told me that Steven's was NOT in the network. At that point, I needed the care and we figured that even if we had to pay, then fine. Now I don't know why they told me Steven's isn't in the network. On my explanation of benefits from my surgery, it says that the hospital has been paid in full and they have to accept that amount as full payment. But, my EOB for my stricture ER visit just says that they made a payment. They don't say that it is paid in full or that the hospital has to accept the bill as paid in full. So, I am wondering if I am going to have to cover the difference. Also, I received a bill from the doc I saw in the ER. He isn't even billing TriWest. So, now I am really wondering if they are in the network. And, if they are, then does that mean that the docs that work there have to also be in the network. Or do we chance going to a network hospital and then getting a doc that isn't and getting stuck with that. I need to go talk to my TriWest rep. I was sure that Steven's is in the network. But, before I went in to talk to her, I want someone to say that yes, they covered 100% of the costs so if they tell me again that Stevens isn't, I can say that I know for sure that they are. Thanks. Hat

I'm pretty sure Steven's is network. (God, they had BETTER be) when I registered the first time there for my nutritional eval, she didn't bat an eye at my insurance. Also ::::::::::putting on my past Ombudsman hat:::::::::::::: I remember being taught that if a hospital takes any kind of gov. funds for research/development in their hospital then they have to accept TriWest. Also, if they accept Medicare they have to accept Triwest. Sure hope those rules haven't changed!

I am impressed that you knew that.

Yes, they do cover Steven's...or else they wouldn't have approved our surgeries...when Pam puts in for an approval she has to state what hosp. it will take place at...I spoke with Triwest yesterday and it covered everything the lady said. She said they wouldn't have approved the hospital if it weren't in it's "network"....I questioned her about one more thing....I may have a slight case of stricture and I was worried about the bill like Hat....I told her my story and how I was sent out for my surgery and my Dr. who completed my surgery would be sending me to the same hosp. for help with my ordeal....she said there would be no problem what- so ever. Sorry to hear you're not having much luck with Triwest HAT...I wouldn't stress over it. Dr. W's staff aslo mentioned they had sent people over to Stevens for after care....and surgeries in the recent past (since they've changed over)....don't worry be happy. By the way....(getting on my bragging box) I can wear size 16 jeans....feels SO GOOD. I got some new clothes because they were having a nice sale at the Bon(macy's) and my jeans and clothes were looking so crappy. If anyone needs some clothes please don't hesitate to ask....I have some 22's, 20's, 18's.....you name it.

wow Rachel, size 16's! WTG! I'm eagerly awaiting when I can get into my wardrobe of 12's! I have tons of clothes in that size from my days working at Northern Reflections.

OK...Why is it that some people have all the luck..I have been stuck in the system trying to get a mental eval...I was told at the appt Tues to just call Tri West...and Walla..a list of Civ head doctors....BTW I get up to 8 visits and may need them all... I made my appt with the PCP when Hat told me that I would need to get my referal from her and my appt is still next week....... I spoke to her on the phone and she still want me to come and and talk some more....What do we have to talk about...the weather, the latest style...my referal.. Can someone get the name of who ever she saw so I can give them a call...QUICK before a policy change again...