Tricare Prime - Got The Referral, Now What?

Ineedalapband · 06-03-2008, 12:58 PM

So I finally got an appt with my PCM today and after much arguing (she had old info, that i had to go to a MTF, needed a specific BMI and 2 comorbidities, etc.) she put in a referral for me.

Where do we go from here? I'm in MS if that matters. Thanks in advance.

Stay_Tuned · 06-03-2008, 01:35 PM

Your referral should show up on the website by tomorrow... and you will also receive it in the mail in about 7-10 days... Once you get that it will have the surgeon you are being referred to and you can call them to get the process started...

Mine sent me a packet to fill out...Made me attend a seminar prior to appt and also I had to schedule a psych eval as well...

one month from seminar to surgery for me....

Ineedalapband · 06-03-2008, 10:26 PM

If they send me a referrel for AL can I call and ask them to change it to another Dr. in LA? Thats closer for me and close to my family. Also, where exactly on the website will I see the referral? Lastly, just because I get the referral that doesn't necessarily mean they will pay for the surgery right?

Thanks, I'm new to all this.

Stay_Tuned · 06-04-2008, 09:03 AM

Yes you can ask them to change the referral to a different doctor...I had to do that for a referral to an OBGYN out in town.....It will take a day or so to show up after the change.... Each area of tricare has their own website... Mine is triwest... So I go to triwest.com I registered and I can see my referrals auths and all that...claims and how much is paid or denied....You just have to register online for it. You could ask over the phone what the web address is for your division.

You are correct the referral to the doctor does not mean you are approved. When I attended a seminar for the surgery I turned in 2 years of my medical records and a copy of my military ID and from there the Doctors office submitted for approval. Once Tricare gets the request the yay or nay comes very quick....

It is ok to be new and ask questions... If there is anything else let me know... I will tell you as much as I know...

Fdiljn · 06-04-2008, 09:03 AM

I am from MS and I too received a referral for a Dr in AL. I had been talking with Dr Redmann's office in LA so I had my referral changed to him. It took 2 minutes on the phone with Tricare to change it.

Ineedalapband · 06-04-2008, 12:32 PM

Thanks for the info ya'll. Fdjin, did you have to submit medical records? Have you been to Dr. Redman yet? Please let me know how things work out since it seems we are traveling the same road.

Were you able to see your referral on tricare.mil?

aculberg · 06-04-2008, 03:04 PM

You took the question right outta my mouth!! I just saw my pcm this morning and he submitted the referral for the surgeon. So my question is, when I get the authorization, and go in for the surgeons initial consultation, what should I expect? What kind of exam is it, etc? I do get to leave my clothes on??!!

Any info on this would be great, as I'm so nervous on what to expect next!

Stay_Tuned · 06-04-2008, 03:10 PM

All docs are different.... I didnt see my Doctor until I was approved for surgery. That is just how she does things... I guess it aleviates any wasted office time for those who insurances are not going to approve. When I went to the seminar and turned in the records they in turn submitted for surgery approval... once that came back as approved I then scheduled to see the surgeon. I was in my clothes they whole time during my first appt with the surgeon....

No clothes off till preop work.....

Fdiljn · 06-04-2008, 03:31 PM

My appointment with Dr Reddman is Jun 12. Yes my referral was on the web site--humana on line I think. His office sent me a set of papers to fill out and they do not ask that I bring my records. I have a copy that I am going to take just in case they want them. They also told me that I could do the psyc eval in their office for $50 but depending on the time and what else they require I will probably go thru Value Options. I do not see a need to spend $50 when I can do it for $12. The other thing that Danielle from his office mentioned was that I would have to be cleared for surgery by my PCM. Not sure what that will require or how long it will take. Guess I will find out next week.

I am hoping to have surgery on Aug 14. That is a long way off but I have some travel scheduled and I have been trying to take this pretty slowly hoping my DH will start feeling better about it. Perhaps I should have done is quickly and then he would not have had as mcuh time to think aobut it. Oh well....

Ineedalapband · 06-04-2008, 06:38 PM

Thanks everyone. Fdiljin, PLEASE let me know how the office visit with Dr. Reddman goes and what they wanted from you. Does he have an office in Slidell or are you going to covington? Lastly, I tried everything to get on humana (tricare south) online and it won't let me get past step 2 in the online thing. I keep putting in a password, etc. and it just clears the page when I hit enter. I don't want to call tricare becuase I know they are going to say "dang lady, you just went to the Dr. yesterday, call back in 2 weeks". Any thoughts? Oh, I've never heard of value options, how does that work?

My husband doesn't really want me to do this either. :(

Also, to the previous poster, do you have any idea what it was that they were looking for in your records? Just curious as my comorbidity is recent and I don't want tricare thinking I don't have one.

Forgive my ignorance on all things Tricare, we've been overseas since I married my husband so I've never had to deal with any of this before.

Fdiljn · 06-05-2008, 09:43 AM

His office is in Covington and I have to go there to see him. There is a Surgery Center in Slidell and that is where they will do the surgery if I am apporved. I remember I had that problem with the Humana site at first but cannot remember what I did to get it to work. I know I had to register at both sites and my password is different.

mphsmommy · 06-05-2008, 10:09 AM

I have Tricare Prime and I am nervous about getting approved. I just changed my PCM, so now I need to get an appointment to go see my new PCM. Do I just go in and tell them I want Lap Band Surgery or do I need to take medical records in with me?

Fdiljn · 06-05-2008, 10:22 AM

I too have Prime and had never seen my PCM. In fact I still have not seen her as she is out on maternity leave. I saw the PA and he asked me why I wanted to have the surgery, what diet programs I had tried, had I considered bypass instead of the band what medications I take, and that was it. I was out in about 15 minutes. Not sure that is usual but that is how mine went. The surgeon's office has mentioned that I must be cleared for surgery by my PCM and I am not sure what that will consist of but guess I wll cross that bridge when I get to it.

Stay_Tuned · 06-05-2008, 10:23 AM

When I scheduled my appt....I told them that it was for interest in bariatric surgery......

IntoLess · 06-05-2008, 12:39 PM

I was told that the surgeon wants clearance from your PCM to know that you are physically able to undergo surgery. More specifically, there are no underlying health problems that may cause complications during or after surgery.