Question:
Tricare prime surgery approval
I was wondering if anyone could tell my what they had to go thru to get surgery approval with Tricare Prime. For example past diets, tests,ect? Any help sure would be appreciated. Thanks alot. Angela — angela35 (posted on February 15, 2007)
February 14, 2007
when I went in there was a waiting list.. so while you are waiting you go
through six months of a nutrition class .. that counts as a six month
weight documentation for loss. that is manditory.. whether you do a
nutrition class or weight watchers.. you have to have a nutrition
documentation for six months of weight. after they call you for your
initial appointment you have a lot of labs, and you have a ekg, psych
appt, nutritionist appt, chest xray, ultrasound, pap smear, then when you
have finished that you wait a week.. so all the reports are in and give
the clinic a call and they set you up for your preop. that is a 3 hour
class and then they give you a date. you will pick up your prescriptions
at this appt for surgery. after that they give you a pre surgery class date
about a week before surgery. that is a 3 hour class on what you are to eat
before and after and how long. they will tell you how many days you are on
a liquid diet. The docs will call two days before your surgery and tell
you when you have to be there. I just went through it and had my surgery
Jan 23rd. I had mine at Portsmouth Naval Hospital, Virginia
— jasonsexybabe
February 14, 2007
I didn't have to go through any of that. I had to do the mandatory pre-op
stuff like psych eval, gall bladder ultrasound, referral from PCP,
nutritionist visit (one visit), surgeon physical, etc. When I had all that
stuff in and submitted for approval by the surgeon's office, it took less
than 24 hours to be approved. Check out my profile to see the timeline from
the first day I wanted the surgery until now. I had my surgery in
CLarksville, TN (Fort Campbell, KY...tricare prime)
Good Luck!
Cherie
— Cheriehott
February 15, 2007
There was no nutrition classes for me. Im still trying to get my approval
to go through but Ive got my sleep test tonight to prove I have sleep apnea
and then I will get my approval.
— lizzieleprechaun
February 15, 2007
Angela,
I did not have to go throught the nutrition class either. I just asked my
primary care giver for a referral to start with. After that there were the
standard tests to get done and a psyche evaluation. Then you go to a
surgeon and the rest is history. I had my RNY on Jan.9 and am down 27 lbs.
Had lost 32 on my own during the testing process so I have lost a totoal of
59 on my journey so far. Good Luck. If you want a friend contact me.
njkbutton
— njkbutton
February 15, 2007
Angela, I am almost 3 years post op, and am Tricare Prime at the time. I
had a lap procedure done, but I understand that changed to only the open
procedure after I had my surgery. You might only be able to have open
surgery done. I took 2 years of my medical records (copies) to my surgeon,
and made a spread sheet of all the diets I had done in past years, did a
sleep study, and took the psy. eval. This was enough with my bmi to get an
approval, they approved the first time. If you have dieted in the past,
get your information organized for your surgeon, and get whatever tests you
can at your base, and take those results to your surgeon on your first
visit. This will help you. The more you make your case organized for them
to review, the better the chance. I also, once I knew that my surgeon had
applied for the surgery, called Tricare every 2 to 3 days to check on the
status. I was not mean or rude, just reminded them that I wanted an update
on how they were doing on my case. You will be your own best advocate. Be
sure you are by doing your job to make things happen and take care of your
needs in this area. Best to you. Patricia P
— Patricia P
February 15, 2007
Tricare still does Lap not just open.
— lizzieleprechaun
February 16, 2007
at ft. stewart ga we had to get recommended by our primary care doc. to the
surgery clinic. then go to a seminar, 2 diet classes, 1 womens diet class,
2 support group meetings, 12 weeks of walk to win classes. then you get
referred to tricare
to have the surgery in civ hosp of your choice.
— karen43
February 16, 2007
I am in Indiana and I am still waiting on approval. But thus far I have had
to get a letter from my PCP stating that I have been illicit drug, alcohol,
and smoke free for the past 6 months. Then I get a call asking for more
letters; one from my PCP stating I have had 6 months of physician weight
management and one from my cardiologist clearing me for surgery since I
have had CHF in the past. I also need either a negative upper GI or a
negative h-pylorie test (this is a blood test). This is to prove to them
that I do not have ulcers. The insurance person at the surgeons office
seems to think after I get these then I will be approved.
— grandmasue
February 17, 2007
I am still going through it but here is what I have done so far:
6 months monitored dieting w/ @least 10 lbs weight loss and no gains
consistent couseling to help w/ emotional ramifications of surgery
having PCM on my side and putting in a refferal
— becky_pogue
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