Question:
I was just wondering anyone with Tricare Prime have this problem
I had a referal with the Doctor, for a second opinion, and he said yes it is Medically necessary for me to have this surgery, he sent the paperwork to the Insurance co. (Triwest), I called today to check on the status, and the insurance lady said that it was to far out, that I need to have surgery within a 30 day period. I was wondering if this has happened to anyone else. Any advice? I have been waiting so..long, is this a good sign for approval? Don't want to get my hopes up high. — Tina B. (posted on February 24, 2003)
February 24, 2003
Tricare is easy to get approval from. I wouldn't worry about that part. The
hard part seems to be finding a doctor that isn't booked solid forEVER!
Hang in there! You might call and ask them for a list of providers, and
start calling them to find one that's not all booked up. My surgeon was at
a military hospital, and he's a general surgeon. I had excellent care!
Don't be afraid to go with a general surgeon over a bariatric specialist.
Just as long as they have a good track record, and all that. :) Ask how
many surgeries they have done, what kind, what kinds of complications their
patients have had, ect. Do your homework, but don't narrow your choices
based on information you don't have, yanno???
— Diana L.
February 24, 2003
i have tricare too. because everyone is soooooo booked what i did was ask
tricare for some names and numbers for network doctors in my area. then i
called and made an appointment even before i got approval(remember you can
always cancle the appointment). as long as it is a network doctor you have
nothing to worry about. i know that tricare is supposed to make the
appointment for you(that's how it was for me) i just called the lady at the
appointment desk after i got the ok and let her know that tricare will be
calling and just give them the date that i already made. saves alot of
time.
— k K.
February 25, 2003
Tina, My advice is to call tricare and explain that an extension is needed
on the referral for surgery. Are you approved for surgery? I know when I
got my approval I was told to call them back with a surgery date. Really it
was so simple to get that approval- a whole lot of worrying took place
though-. I also had the surgeon send all the paperwork for approval to the
local office at my base not the regional office down in Phoenix- Check to
see where you papers were sent. On your referral they only list the address
of the regional office. I knew if it was sent there it would take forever.
The local triwest office approved my surgery in about 4 hours. Good Luck
— Jan S.
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