Question:
Tricare Prime VS standard HELP!

OK I have a question! I have tricare Prime now. I will be tring to get my Recontructive surgery... Abdominoplasty and thigh stuff done. What if they deny me? Can I switch to Standard and get it done and pay my 20% and they HAVE to pay the ohter 80%? Or does it still have to go through approval? I have no clue how Tricare works! Someone PLEASE HELP!!!!! ANYONE HAVE PS with TRICARE?    — Sabrina H_NC (posted on December 30, 2003)

December 30, 2003
there are 2 ways that you can do it. one is to have a history of rashes, back pain, boil and skin tears. you have to see your pcp for this. then go to your pcp for a referal for ps. the second way (and sometimes easier depending on where you are) is to try and have it done at a military hospital. you can go online for the military hospital in your area and see what surgeries they do. you can also go to www.tricare.com and search for reconstructive surgery. read the wording over and over untill you know it by heart, that way you will know all the documentation you will need BEFORE you send anything to tricare. most times once you are denied for reconstructive surgery..it's all over(even with trying over and over...and i'm not a pushover! hahaha).there isn't a huge team of people looking at your info. it all goes to the same people in your region and once they say no..they don't want to say they were wrong. remember obesity is a diesease. and you did have surgery. to you could also use the fact that it is to return body function. just read it carefully. also you can go on base or to the hospital and they should have a tricare person there to speak with inperson. this is a good place to start because you can ask what it is that you need.
   — franbvan

January 3, 2004
I have Tricare Prime as well and I have yet to even have my surgery (scheduled for Jan 7th) so I'm not even thinking about PS yet, but I was talking to another military wife at a Christmas party that had the surgery and she is considering PS and she told me that you can go to a military base/hospital and they do it there and it's covered, So definately check into that first before changing to standard. GOOD LUCK!!
   — Tracy P.

January 18, 2004
I second what the other ladies posted. Definately check out all your options. Oh, and as far as standard goes...yes, you still have to get approval/prove the surgery is medically necessary for them to cover it. They don't just automatically "have" to pay that 80% and won't if they don't have to.
   — Anne R.