Question:
Does anyone have any experiance with Tricare Level Three Review?

I was denied gastric bypass surgery and requested an expedited appeal I found out today that it is in 3 level review, what is the differance between 2nd and 3rd level review? I thought that it would go back to 2nd level review just with a differant review board. If I am denied this time where does my next appeal go? Anyone have any experiance with this?    — S C. (posted on June 19, 2003)

June 19, 2003
I have tricare prime, and my surgery is August 6th. I was told the only time that a approval has to go to 2nd or 3rd review is if you choose a surgeon that is "out of network" I orginally wanted a surgeon "out of network", but was told it would have to go to review and could take 3 to 6 months for approval, and may not be approved, and if it was approved I may have to pay 60% of the cost. So I went with a "in network" surgeon, and got my approval the same day of the referral from my pcp. You may want to check with tricare and see if you are requesting an out of network surgeon, if so, maybe you can halt the review board and start your WLS journey. hope this helps
   — cindy

June 19, 2003
I got my approval my insurance delima is over. Thank you all for your help, now for the post op questions and worry to begin. I am so happy!!
   — S C.