Am I approved through Tricare?

minpinmom · 07-16-2006, 02:53 PM

I've got a question . . . I went to my Dr., he put in the request for me to see Dr. Spiegel and said now we have to see if you get approved. That was July 5th. Online it shows I was approved for 6 visits to Dr. Spiegel for "Obesity" on July 11. Does this mean they have approved me for the surgery? Or just to go see him? 6 visits seem like a lot if it isn't for surgery. I have Tricare insurance and was wondering if anyone that has gone through this knows. From what I have read, it normally takes a lot longer to get "approved". Thanks for your help and advice.

jennut · 07-16-2006, 03:21 PM

My husband was in the army about three years ago and then Tricare would not cover a surgery like this. I would call Tricare direct and ask them what has been approved. It sounds like just office visits. That would be helpful for the fills you will need for your band after surgery. I was banded by Dr. Spiegel on June 23. I was self pay so I don't now about all the approval stuff.

Good luck!

minpinmom · 07-16-2006, 07:03 PM

I am an Army Brat, Air Force wife (retired), it shows (now) that they do cover it if you meet the requirements, and my PCM put in a referral saying that I meet the requirements. I called Tricare and asked them what the referral was for specifically - and they said for Obesity - I guess I have to wait and talk to Dr. Spiegel's office. Did you like Dr. Spiegel? I have read just about every thread on here and a lot of people didn't like his staff - what was your experience.

GinaJ · 07-17-2006, 07:49 PM

Currently, lap band surgery is a non covered benefit with Tricare. However, they do cover the RNY surgery, and they will cover a paniculectomy (tummy tuck) after having gastric bypass surgery.

jennut · 07-17-2006, 09:02 PM

Dr. Speigel's staff has been very nice and supportive to me. I don't know why there are so many negative comments about his office staff. I didn't have to deal with any insurance issues so I don't know if maybe that issue makes people more frustared and alters their opinion about his staff.

Good Luck!

minpinmom · 07-18-2006, 10:18 AM

Jennut Yeah, so far so good. I have read a lot of negative on here, but so far everything is fine.

GinaJ Tricare says they cover Lap Band on a case by case basis. The lady I spoke with says that since I actually got a referral for office visits, the surgery referral shouldn't be a big deal. I should know more tomorrow, I go for my first visit with the surgeon.

Thanks for all your help and advice.

GinaJ · 07-18-2006, 08:13 PM

I work for Tricare. Maybe it is different, depending on which region you live in.

minpinmom · 07-18-2006, 08:52 PM

Gina Maybe so I am in Tricare South - when I called they said they don't cover it - I kept inquiring and she said to have my Surgeon sendin the paperwork - that they send it in for case by case approval.

Sounds like I have a lot of work ahead of me though.

I was sooo excited when I got my referral, I thought that was all I needed. Little did I know . . .

dallman · 07-19-2006, 01:35 PM

Minpinmom are you Tricare Prime? I am in the south area also Nashville area. I have called and they told me it is not authorized. I have asked them about case by case and they said it was not done. Please keep us informed as you work your way through this mess.

Thanks,
Don

minpinmom · 07-22-2006, 07:58 PM

I sure will. I had my first visit with the surgeon, his office said they have done only a "couple" of Tricare Prime clients - out of 4000 in the last 5 years. So it might be hard. I met a lady at the seminar who dropped down to Tricare standard, she said they will cover 80% of the cost. So, I will fight once I get my 1st rejection, if it takes too long, I will see about dropping down to Standard.

But, I will keep everyone posted.

minpinmom · 07-24-2006, 08:51 PM

Well, I can't believe it, but Dr. Spiegel's office called today and they said that Tricare will pay 100%. I have to get a psych eval, go to a nutritionist and get all of my medical records. I am in shock, I can't believe it. I keep thinking that they are going to call me back and say there was a misunderstanding.

What a day.

Mvpo8961 · 07-24-2006, 09:24 PM

Congrats and RUN WITH IT!!!!!!!!!!!!

Myra

gagretta84 · 11-17-2006, 07:45 PM

where is dr speigel located at

leslieidavis · 11-27-2006, 10:45 PM

I am in Fairbanks, Alaska and I am also an AirForce wife. Did Tricare cover your surgery? Today is my first day on this site. I am waiting a call to find out if they cover.