If your retired military TRICARE is a pain.....

Hi all , I've got to vent. I'm having my bypass a week from monday with Dr. Hutcher in Richmond. I just got a notice from tricare . they will not cover the diagnosis on the Sleep apnea test .$1200.00. Even tho i needed the test for them to  approval my bypass? It has been 7 months of test to get to this point and for them to do this feel like a nail in the coffin. It make me wonder how much of the operation they'll cover.?

Why did you have to have that test?  I have Tricare Standard and didn't need that test for approval. They covered pretty much all of my surgery.  Call them, and ask.

I had to have four appointment cardio , psyc, nutrition and pulmonary.. The pulmonary said I needed the test pre op because that would make a difference in how I came out of the anesthetic These are the requirements set by tricare Prime to get approval. Being retired military I can't go to the base and get these done. Tricare sets you up with an outside primary care physician, who has to then refer you to the bariatric surgeon. My first referral from Tricare was to a surgeon who didn’t even do the surgery. It took me 3 referrals to get the pulmonary appointment approved. Now they tell me the preop test didn’t get the diagnosis they wanted so they aren’t going to pay. That's what the paper says “NONCOVERED DIAGNOSIS”. I did call them and they said I would have to appeal. After 7 months of fighting (for appointment that they require) with Tricare Prime I'm very disappointed as to how they treat retired military.

I was Tricare Prime that changed to Tricare Standard so I could have the surgery "on the outside" without waiting on referrals from Portsmouth, etc. I (and any others in my situation) were not required to have cardio and pulmonary testing.  And there is nothing on their website about it.  I did have to have the psy and my doc has the nutrition.  So, not sure where that comes from, unless it was your doc's requirement. And if that is the case, then that may be why they are not covering it.  Never heard of "noncovered diagnosis".  Ha!  Makes ya want to go back to the doc and ask if you can have a diagnosis that is IS covered.  HAHAHAH Good luck!