Tricare question Help

ok out of curiosity if tricare apprives the referal to go to the plastic surgeon does that mean the surgury will be approved?  or does it mean i have to get another referal after the office visit?

please help im not sure if i should be really happy my referal was approved or relieved i have gotten one step closer

Thanks
Terri

I have a question for you, but no answer.  How did you get a referral to the plastic surgeon.  I have Tricare too and was wondering if and when to start the process.  I think you're on your way.  What procedure are you thinking about?  I'm needing a TT in a bad way.
Reggie

Hello well i am 15 mo out and have maintained myt weight for over 6 months and i guess for tricare that is important because if they approve it they only approve it once i was told so they want you to make sure you have lost a majority of the weight. as for the referral i went to my pcm yesterday to talk about a TT and BR and  he put in the referral after going over my records rashes back pain and put in the referral i got the notice that the referral to the PS was approved today so it was super fast but i guess from what i am hearing that is the easy part gettting tricare to approve the surgery is the hard part i have no idea im now just in a waiting game hoping someone will know the answer.

Terri

I was talking to someone on the RNY Forum and she said that it has to be stated as "a medical necessity" by the Dr's orders and Tricare will approve it.  So I hope your visit to the PS will get you the go ahead.  She said that its all in the wording, Good Luck and please keep me posted on your progress.  I'm right behind you!
Reggie

The surgeon will still need approval for any surgery. It sounds like you meet the standards for Tricare to cover a panni. I'm not sure about the other. Good luck!

Just getting the referral from your PCM does not constitute approval.  Once you see the plastic surgeon he/she will submit documentation of medical necessity and then Tricare will decide whether or not you meet the standards.  I have known people who were turned down by Tricare and I have known people who were approved.  You will want your surgeon to submit a letter or something from your PCM stating how long the skin issues have been going on and that they are resistent to less invasive treatment.  Many times the trick is to find a PS that will accept Tricare.  Many PS are on the Tricare panel -- but they will not work with Tricare on panni removal or TT.  That was my experience with finding a surgeon that worked with Tricare.  There were several surgeons in my area that were Tricare authorized providers, but when I called they would not take Tricare for this type of surgery.  I finally found a wonderful surgeon about 85 miles from my home who would take tricare for this surgery.  So they are out there.

Red