Help with Tricare South (Standard)

I have Tricare South Standard. I have an appointment with my PCM on Wed. to ask for a referral to a surgeon. But if for some reason my PCM won't give me the referral, and as I understand Tricare Standard's policy, is it okay for me to just see the surgeon without a referral (as long they are in Tricare's network)? I have never had to have a referral to see a specialist with Tricare Standard and I was wondering if this would be the same kind of situation. Also, I would love to hear from anyone who has had to deal with Tricare South Standard for WLS. Was it hard to get approved? Did it take a long time?, etc...

Hi there, I am Tricare Prime in the North Region....It is my understanding that with Standard that you do not need a referral.  Double check the website or call them.  But, I can give you some advice as to what they will be wanting.... Authorization Form, Psyc Eval, Letter of Medical Necessity, EKG, Full Lab work up this includes Thyroid panel and Hypolri.  They will also need Polmonolgist clearance, and nutrician consult.  They may or may not request a 5 year weight history.  Oh, and make sure you fall within their requirements.  100lbs overweight with comorbidities, or 200% over ideal body weight (they use the metropolitan weight table).   Oh, FYI on 12/10/07 they updated the benefits and in February of 2008 they will cover lap band. Just have all your duckies in a row, and if you call or talk to them make sure to document, document, document....  I wish you luck. It took two months of jumping through some hoops because they gave the wrong information requirements to my surgeon's office.  My surgery is scheduled for 12/28 after being approved on 12/13.

Thanks for the info! I wanted to update and say that I did see my PCM and he doesn't think I should have the surgery any time soon. He wants me try more diets and see what happens. Needless to say, I don't particulary agree with him. He said I am too young (28) to have it and he said that the bariatric surgeons were only in it for themselves and just want the money (!). Whatever. Anyway, about Tricare requirements-I am more than 100 pounds overweight according to that weight scale and I have hypertension for which I take medication.  BTW, I called another surgeon that I was interested in seeing (other than the one listed on my profile) and they said that I do not have to have a referral and they scheduled my consult for the day after Christmas. Yay!  P.S. Wendi, I wish you much luck with your surgery. I will be praying for ya! (What a wonderful Christmas gift!)

SInce you are on Standard, you should not need a referral to see the surgeon. There is nothing stopping you from finding a more supportive PCM. You are on Standard, as long as the doctor is in the Tricare Network, you are free to change doctors.  To be honest that would be my first move, to find a more supportive PCM.    It is your PCM job to listen to your health concerns and response to them.  It is not his/her job to pass judgement, or pass his/her personal opinions on to you. If WLS is important to you, it should be important to your PCM. I am on TRIWEST PRIME, and it was very easy to get approval.  I think the approval was so easy in part because I have a great PCM at  Elmendorf.   I had no problem getting all the pre-ops test done on base. My surgeon faxed in the approval reguest on Friday, and had the approval Monday afternoon.