Question:
Tricare - can anyone help me with the process for approval. (long-sorry)

My situation is a little different and I'm just trying to see if anyone has any suggestions for me. I am a military dependant, insured through Tricare Prime, BMI is 44.6, multiple co-morbidities. My PCM is civilian as there was none-availability when we PCS'd here last year. All medical tests, etc. that I've had in the past year have been through civilian docs and facilities. So, I'm trying to figure out the best process for approval. I have an appointment to go over my "stuff" with my PCM, including a letter listing my diet history, co-morbidities, etc. I don't think she'll hesitate referring. But, do I ask for a referral to a bariatric surgeon, see them for a consult, and then they refer for surgery? OR, does she just refer for surgery? AND, does anyone know if, since I'm farmed out to civilians for other med stuff, will they send me through civilian channels (similar to Standard) for the surgery? This is preferable because of the wait list at NMCP. Also, has anyone who has been approved for WLS by Tricare Prime had to have a medically supervised diet before approval? I've had a number of medically supervised diets over the years, but the most recent was over 2 years ago. Thanks!!    — Mholli5 (posted on October 10, 2006)

October 10, 2006
Hi. I just had my surgery Nov. 17, 2005. Paid for by Tricare Prime. All your doctor has to do is put in a consult for the bariatric surgeon and he will decide if you are a canidate or not. Have him let you know how many visits you will need so you can get your doctor to put in another consult to cover all of the visits. I'm in Texas at Fort Hood and they sent me to a off post surgeon. Just depends on if they have a shortage of doctors at the time. Most of your tests if they are within a year should be fine for the surgeon. Might be a few that have to be less than a year but process shouldn't take that long. Good luck!!!! Carrie
   — HubbysBrat

October 10, 2006
Tricare is one of the easiest to get approved. If you meet the critia you will be approved. YOu just need to find a gastric bypass surgeon who takes Tricare prime and then have your dr submit the referrel to tricare ..Good luck
   — Catherine B

October 10, 2006
Another Tri-Care prime WLS patient here.... had mine in Feb almost 2 years ago. Although I had mine done on post with an Army surgeon. My approval came back in one week, as long as you meet Tricare's minimums (and you do) and the doctor that you see is YOUR ASSIGNED PCM through Tricare then all they have to do is document your efforts, your qualifications, and a good referral letter to see a bariatric surgeon.Its that easy. They key is that the referral has to come from your tricare assigned PCM!
   — MagickalMom

October 10, 2006
I'm in the same boat, except that I have all on post PCM's, but they decided to refer me to off post to have the WLS laporoscopically, and they only do it it open here on post. I haven't heard of anyone with Tricare Prime being required to do the supervised diet. I think you'll be fine. Just need to get your sleep study done, your psych eval, and your surgeon will schedule all the other tests for you: ie. scope, gall bladder ultra sound, visit with nutrician, etc. Let us all know how it goes! Cherie
   — Cheriehott

October 10, 2006
Hi I am actually leaving in the Thusday morning here for surgery. all you really have to do since you have multiple co morbids is ask for a refferal. once Tricare gets all of you information they will take a few days to approve you i did not have to be on any doctor supervised diets or anything like that. they make the appt for you to see a doctor on the economy i am seeing one in Frankfurt Germany. the do their tests and stuff set you up for a surgery put in the final approval papers and should be all it takes. hope this helps. Frances
   — LunaOrb

October 10, 2006
I had my surgery on 4/19/06. Tricare Prime. Went to a civillian dr. but Tricare made me go thru 6 months of weigh management with my PCP....you have to go in once a month to specificly talk about your weight, it HAD to be charted somewhere on my paperwork other then them just weighing me. There was alot more that i went thru, but the process was rather cut and dry of what they wanted. it went fast and i am now 6 months out and down 100lbs. If you have any questions, or just need to talk feel free to email me [email protected] Take care~ jennifer
   — jenzstory

October 10, 2006
tricare prime was easy for me,my bmi was 41 plus i had some co-morbids, my civilian pcm put in my referral for wls i was approved fast and got deferred out for a civilian doc, i didnt have to have any proof at all of diet attempts, just the standard tests that the surgeon required. it was easy. the only thing was worrying about the long wait. i got lucky there also. good luck!!
   — shellypoe

October 11, 2006
I had my surgery Feb. 4, 2004. Had civilian PCP, she requested consult for surgeon that accepted Tricare Prime, after referral came through, saw surgeon, did all his required tests in one week, then had psych evaluation as required by Tricare. After surgeon put in request for sugery approval to Tricare, I was approved within 24 hours. Biggest wait was for opening in surgery schedule.
   — MarjN