Question:
Does anyone have Tri-Care Prime ins.? I was approved for RNY surgery but not endoscop

has anyone had ths problem? i get a date tomorrow, but without that test the surgeon won't do the surgery. any suggestions are appreciated.    — Robyn (. (posted on April 19, 2000)

April 19, 2000
Tricare Standard paid their share of my endoscopy, no questions asked. The only surgeon-required pre-op test they did not cover at all was my psych evaluation. If Tricare Standard will pay for an endoscopy, then Prime should as well. My advice is to have your surgeon call Tricare,speak to the doc or patient rep who denied the coverage, explain his requirement, and see if they'll cover. It's possible that a compromise can be reached. Perhaps an Upper G.I. is something Prime will cover and your surgeon will accept.
   — Duffy H.

May 18, 2002
Tricare Prime is a nightmare! We pay for the extra insurance only to have the primary care manager's diagnosis questioned. From there a consult is deemed necessary by Tricare, which they then refuse to pay for! From here is gets ugly, especially if your primary care manager is sent overseas for 120 days and someone else has to respond to the consult. You, the patient, have to provide oversight continuously and get a champion. Unfortunately, I find that although Tricare Prime authorized the surgery, they are paying less than 50%! This is what we pay for - thank you Congress!
   — maria F.