Question:
TRICARE PRIME TRYING TO GET AN OFF POST REFERRAL

Hello everyone I'm trying to find out if i can get a referral to see a surgeon off post since on post is taking me through so much to get the surgeon as i have saud before they are making me see the nutritionist until she gives me the ok for the surgery which it does not seem like shes really for the surgery it kind of seems like she is against it and she told me to show progress in her class such as losing weight and that i may get approved by her afterwards so i was wondering if i go to a surgeon off post i know i will be required to do different things but i hear i will stand a better chance off post and things go alot smoother also there is no waiting list on post so that is why i was thinking i will not be able to get an off post referral so can someone please help me out and tell me what i should do to get an off post referral thanks to all    — JENNIFER S. (posted on July 4, 2003)

July 4, 2003
i don't mean to be rude, but you have asked this question before and people answered. to have wls and tricare pay for it you don't need to go to a nutritionist...no matter what the pcp told you. that is NOT a requirement to get a referal for this surgery. go to the website, print out the requirements for wls and take them to your doctor. if you meet the requirements then she must give you the referal, if not call the tricare office and switch to a different pcp. even if you use an off post doctor you won't have to go to the nutritionist for tricare to pay for it. i'm using and off base doctor. you pay for tricare and wls is a covered treatment. if you choose to stay with a foolish doctor even after you know what the tricare handbook says that is your problem for not speaking up. i'm not trying to sound harsh, because i know how important this surgery is to you(and to me). i just want you to understand your pcp isn't doing what they are supposed to and you aren't doing anything about it. remember...they work for you, you don't work for them. your pcp is there to treat you, not to understand how tricare insurance works(and believe me they don't), so bring it to her attention. good luck to you.
   — franbvan

July 4, 2003
I have Tricare Prime insurance also and am stationed at Ft.Hood, TX. My PCM also told me that she would need to have documented by a nutritionist that I had failed all attempts and then she would refer me. This policy is not Tricare's but rather the MTF ( Darnall Hospital ) that requires it. Your PCM is basing their decision to refer you based on the requirements of your MTF. I was blessed to have a nutritionist who told me it was only a formality and just had me come to 3 classes to ensure I was aware of what the surgey and post op nutrition would really be like. I would suggest changing your PCM at your Tricare service center. I would ask around at the clinic you go to to find out who is the best doctor to give referrals for the surgeon. I was able to get a referral off post because of the waiting list of 12-14 months as long as the doctor was as in network doctor. I am driving 5 hours for my surgical consultation on Aug 22, 2003. If I can be of any more help feel free to email me at [email protected]
   — Selinda M.

July 4, 2003
The first thing you need to do is call the Tricare office. You need to ask them if you have the surgery on base if a nutritution visit is required. Tricare does not pay for any weight loss classes or teaching, so they can not require you to have a nutritutionist or weight management appointments. If you are still wanting the surgery done on base, and they do WLS on base, then you need to follow the pcp's request. Your pcp on base can give you a referral to a surgery off base, but the surgeon has to be in the Tricare network. The second question I would ask Tricare is who is the surgeon off base, I would get the surgeons name and phone number and call there office and find out about the waiting time for surgery. My surgeon required that I attend a Weight Management Seminar, and then take a Psch test and see a Pschcologist before I could get the first consult. The other poster is correct, it is not Tricare that is requiring the nutritutionist it is your pcp. That is the last question I would ask Tricare, can my pcp on base require me to see a nutritutionist. Hope this helps
   — cindy

July 4, 2003
I was at Ft Hood waiting almost a year and then because of deployemnts they cancelled all gastro bypass surgeries. You can be referred to San Antiono or other bases, Air Force too. I left in March and they were not approving off base in my area at the time. I did have my psyc exam, 3 nutrition classes, upper GI and blood work all at Ft. Hood but then started to go to San Antonio to wait another few months there. San Antonio also required addition testing. I had to come back to FL because mom has cancer. Fortunately for me I had my surgery in FL May 15th. I was approved in 6 weeks for surgery. The only delay was my surgeon insisted on gallbladder being removed and I had to appeal it two times. Other than that the surgery was approved in a week. I hate to say it but if you are at a base that requires surgery on base with long wait, go home and have it done by civilian, its much faster. Feel free to email me any time [email protected]
   — Michelle S.

July 5, 2003
You may not be required to get approval from a nutritionist, but my insurance did. Now that I am post-op this is what I am most thankful for. As far as my surgery I sailed through with no complications. But, trying to figure out what to eat, what not to eat, when to eat. It is all time consuming. Be glad for what you can learn in the nutrition classes required. This is what will determine how successfull the surgery will be. This is life-long, not a quick fix. You really need to know this information and the sooner you learn it the better off you will be.
   — tonyapf