Question:
Where to begin if you have Tricare Prime?

Ms. Lopez said that Tricare will deny if there is a military base nearby doing the surgery. So where do you go to begin the process - your local PCP [I'm a retired dependent], contact the base doc's office directly, or some other route? All of the various posts have gotten a bit confusing I admit, and I'm not sure where is the best place to begin or what I can do to facillitate the whole process. Is there anyone out there who has used Tricare Prime who would be willing to walk me through the process, or just share their experience? I'd be totally grateful for any info that anyone would be willing to share. Thanks for all and God bless, Cas    — Casca L. (posted on April 30, 2003)

April 30, 2003
This is what I had to do. 1. Get a referral from my PCP on base. I don't usually go to the base to see the doctor, so I just made an appt. with family practice, with the doctor to whom I was assigned. 2. Ask that doctor for a referral for bariatric surgery. This is where it can get tricky. Sometimes, they don't do the surgery at the base nearest you. In that case, you will get a referral to a doctor out in town. OR, if they doctors are deployed, or whatEVER, you can get a referral out in town. I had mine done on base, and there was a HUGE wait list. 3. After you find out where you are going, make an appt. Then you'll find out what you need to do next, in terms of testing, ect... I have to say it was FAR easier to just wait and have the surgery on the base. I didn't have to pay for a thing, and didn't have to bother with tricare. It was all done for me, without having to submit paperwork, call anyone, or worry about bills for uncovered things. The waiting wasn't easy, but it was worth it. :)
   — Diana L.

April 30, 2003
I just went through the process in San Diego. In order for Tricare to cover the surgery.... 1. See your primary care doc for a consult for bariatric surgery. In San Diego, it has to go to the surgery department first, where they will send on to Tricare Health Care Finders stating they do not perform this type of surgery. 2. Tricare will then evaluate the referral and make sure you meet the requirements. 200% of your ideal body weight (example if 130 was your ideal you would weigh 260), or 100lbs overweight with a comorbidity (diabetes Hypertension etc) Then after that, if all is good, you will get a referal to a doc out in town. Then, the doc out in town will take over. Find out if they do this surgery at the base. (near by is considered a 50 mile radius I believe by Tricare) If the base performing these is over 50 miles away, they should refer you out in town. Be proactive, and see what providers for this surgery are covered and accept Tricare. I chose to drive about 100 miles to a doc in Orange California and it was wonderful. (Tricare doc too) Don't limit yourself. I hope this helps. I found the paperwork was the most time consuming, but once my initial referral to go and see the bariatric surgeon was in, it was a piece of cake. The Surgeon took over requesting the surgery and getting it approved. Email if you have anything else I can help you with.
   — dimpkd

April 30, 2003
First I want to say that Tricare Prime is the best insurance, and I thank my husband who is retired, who served his time, and made it possible to have Tricare Prime for our insurance carrier. Is your pcp in the Tricare Prime network? You do not have to use the base, I live 35 miles from an AirForce base and I never go to the base. If your pcp is in the Tricare Prime network, and you feel good about him/her putting in a referral to see a gastric bypass surgeon, then you can go to "find a doc" on this web site and find a surgeon that excepts Tricare Prime, then go to your pcp and if it is medically necessary, they can put in a referral for you, and Tricare Prime will come back with an approval or they will need more information. I have a list of things that goes on your referral on my profile, please take a look. Hope this helps
   — cindy

April 30, 2003
I also wanted to add that I have had a very good experience dealing with Tricare Prime. I live on Ft. Polk and we have a surgeon here who does the surgeries but I felt very uncomfortable having the surgery done at a military hospital. Lucky for me, the surgeon deployed. So, I saw my PCP who put in a referral for me to see a civilian surgeon. He submitted the request to Tricare. 24 hours of receiving the request, they approved it! Easy as pie! I had to have a psych consult and once my surgeon had the approval and the okay from the psychologist, we set a date! I am having my pre-op done on May 12th and surgery on May 19th. So, good luck to you. Start with your PCP and it should be easy from there as long as you meet the requirements.
   — Tami H.