Tricare Standard? San Diego?

Thread Starter  

PCM M.D. San Diego
I am jumping through the lap band hoops..haha..I made a funny. ~Anyway~ I have a serious question. I am hoping that someone on here has had the Lap Band surgery in San Diego using Tricare Standard and can provide the name of a PCM to give me the referal that I need to UCSD for the initial consult. In a nutshell, if you can answer yes to the below questions and then still have an aswer for me, please respond:

-Did you go through the lap band process?
-Do you have Tricare Standard?
-Does your PCM know how to do the referal to Tricare in a timely manner?
-Could you please tell me who your PCM was?

Thank you, Mahalo, Gracias..etc

diane

I thought if you are tricare standard, a referral is not needed. I'm Tricare standard in Texas and I just found a surgeon who accepted tricare and went to his seminar etc. No referral needed at all. That's just tricare Prime, I think?

__________________

PCM 7/3/08 Seminar 7/10/08
Upper Gi, Psych,Nutrition, Surgeon 7/25
Tricare Approved 7/31
1st surgery 8/11 fatty liver no band
Banded 8/29/08!!!
Dr. Sonny Cavazos, Texas Bariatric

Thread Starter  

I went to the seminar and then made the appointment with the surgeon. The surgeon's office called me and told me that they had called Tricare (just to be sure because the inital 3 hour office consult is $1,000 out of pocket if you don't have insurance). Tricare told them that I needed a referal from my Primary Care doctor, even on standard, before I could see the specialist.

I had a feeling it wasn't going to be as easy as I though it might be, just switching to standard, and it appears that it isn't. Now I am trying to locate a doctor that "understands" what being obese is like, rather than one that will just insist on me seeing their dietician and giving me a meal plan. Hence my initial question Does your PCM know how to do the referal to Tricare in a timely manner?

Thread Starter  

This is the actual email that I got from the lap band surgeons office:

Hi Diane,

This is a reminder that you need to contact Tricare and establish care with a Primary Care Physician (PCP) and have them obtain an authorization from Tricare for an office consultation with Dr. Garth Jacobsen.

Please have your PCP's office fax us the referral to 619-543-7785. If we do not receive the authorization before your scheduled appointment on 10/20, we will need to reschedule.

If you have any questions, please call our office M-F 8-4:30pm.

Thank you and look forward to seeing you soon.

Catherine Dooley

I have Tricare Reserve Select (which is basically Standard for the Reserves and NG), and am not required to have a referral. I didn't realize that until I PM'd Restless Monkey for info; her response (thank you!) prompted me to call and check again with Tricare, who told me I didn't need a referal and also gave me a list of preferred providers for bariatric surgery in my area. My surgeon's office at first told me I would need one, until I repeated that I had Reserve Select/Standard and NOT Prime, and they said I was correct that I didn't need one. From the sound of it, I think it depends on who you get on the phone at Tricare, and how well they listen to you.

__________________
9/18 - Seminar with Dr. Erbella
9/24 - Psych eval
10/6 - Consultation
10/10 - Submitted to Tricare for approval
10/14 - Tricare APPROVED!!!
Trip to Isla Mujeres Nov. 18-25
12/1 - Preop testing
12/3 - Surgery

Thread Starter  

I have copied and pasted a whole bunch of stuff off of the internet from the actual Tricare website and forwarded it to that secretary. Hopefully tomorrow I can call Tricare and get an answer (and a name) for them so that I can get seen without a provider referal.

I know this is so weird because I never had to do this before.