TRICARE PRIME - US Military and RNY

For all of you in the Washington area who have had surgery - either at Madigan or elsewhere - I need question answered. Did you just go to your doctor and they did all the paperwork? When you got your date, did you get an authorization number. I have surgery scheduled at Madigan for Dec 1. I've read the horror stories about no coverage, so I contacted lady in charge at Madigan (not Tricare lady). She said everything is a go. She also said she would not be able to schedule if it were not approved. Did any of you contact Tricare yourself prior to make sure,,,,or did anyone get an authorization number? Or, did you just go on what doctor's staff said to be true? HELP!!

I never received a letter from TriCare stating I was approved. I did my pre-ops at Madigan and was told I was on their waiting list and would be given a call closer to the time I hit the top of the list. After waiting 9 months I called the general surgery clinic and told them to take me off the list because I decided to get it done off-post because I was tired of waiting. The very next day I got a call from them offering me a date the next month. I had my surgery before TriWest took over for TriCare so I don't know if things are handled differently now. All I can say is I never got a letter of approval from them and never received anything after surgery showing how much they paid for the surgery. But then that could be because I had everything done at Madigan. I met all of TriCare and Madigans standards for surgery and was pretty much told at my first consult that I was approved. ~Tanja -107

That's the same with me so far. Was told at the get-go that I was qualified. I just have this fear of getting a bill after-the-fact because I did not contact Tricare first. Secretary at Madigan said everything was fine. Guess I should quit borrowing trouble. Thanks for the response.

Since you are having your surgery at Madigan, TriWest isn't involved at all. They aren't contacted and you don't need their approval. Your surgery doesn't cost TriWest anything at all. So, they don't care what you do. Military doctors are paid by the military and can't bill you. Same for all of the supporting staff. The only thing they will bill you for is that daily fee of something like $10 a day. If you are still worried, I can look it up for you. This is also why MTFs can do lap, but if you go with a civilian, you have to have an open. Tricare doesn't (can't?) dictate what MTFs do because it doesn't affect Tricare at all. Hat

i had my surgery 31 aug at madigan. i never had to deal with triwest, or go through any paperwork. the only pre-op stuff i had to do was the blood labs they took the day before my surgery. the surgeon even told me its not even a requirement to do the other classes, for behavioral and nutritional, meerly a suggestion... as far as the 10$ a day, i never saw that bill either... i have been hospitalized at mamc twice since i have been here and i have never seen a "room & board" bill.