Question:
TRICARE PRIME TRYING TO GET AN OFF POST REFERRAL
Hello everyone I'm trying to find out if i can get a referral to see a surgeon off post since on post is taking me through so much to get the surgeon as i have saud before they are making me see the nutritionist until she gives me the ok for the surgery which it does not seem like shes really for the surgery it kind of seems like she is against it and she told me to show progress in her class such as losing weight and that i may get approved by her afterwards so i was wondering if i go to a surgeon off post i know i will be required to do different things but i hear i will stand a better chance off post and things go alot smoother also there is no waiting list on post so that is why i was thinking i will not be able to get an off post referral so can someone please help me out and tell me what i should do to get an off post referral thanks to all — JENNIFER S. (posted on July 4, 2003)
July 4, 2003
i don't mean to be rude, but you have asked this question before and people
answered. to have wls and tricare pay for it you don't need to go to a
nutritionist...no matter what the pcp told you. that is NOT a requirement
to get a referal for this surgery. go to the website, print out the
requirements for wls and take them to your doctor. if you meet the
requirements then she must give you the referal, if not call the tricare
office and switch to a different pcp. even if you use an off post doctor
you won't have to go to the nutritionist for tricare to pay for it. i'm
using and off base doctor. you pay for tricare and wls is a covered
treatment. if you choose to stay with a foolish doctor even after you know
what the tricare handbook says that is your problem for not speaking up.
i'm not trying to sound harsh, because i know how important this surgery is
to you(and to me). i just want you to understand your pcp isn't doing what
they are supposed to and you aren't doing anything about it.
remember...they work for you, you don't work for them. your pcp is there to
treat you, not to understand how tricare insurance works(and believe me
they don't), so bring it to her attention. good luck to you.
— franbvan
July 4, 2003
I have Tricare Prime insurance also and am stationed at Ft.Hood, TX. My PCM
also told me that she would need to have documented by a nutritionist that
I had failed all attempts and then she would refer me. This policy is not
Tricare's but rather the MTF ( Darnall Hospital ) that requires it. Your
PCM is basing their decision to refer you based on the requirements of your
MTF. I was blessed to have a nutritionist who told me it was only a
formality and just had me come to 3 classes to ensure I was aware of what
the surgey and post op nutrition would really be like. I would suggest
changing your PCM at your Tricare service center. I would ask around at the
clinic you go to to find out who is the best doctor to give referrals for
the surgeon. I was able to get a referral off post because of the waiting
list of 12-14 months as long as the doctor was as in network doctor. I am
driving 5 hours for my surgical consultation on Aug 22, 2003. If I can be
of any more help feel free to email me at [email protected]
— Selinda M.
July 4, 2003
The first thing you need to do is call the Tricare office. You need to ask
them if you have the surgery on base if a nutritution visit is required.
Tricare does not pay for any weight loss classes or teaching, so they can
not require you to have a nutritutionist or weight management appointments.
If you are still wanting the surgery done on base, and they do WLS on base,
then you need to follow the pcp's request. Your pcp on base can give you a
referral to a surgery off base, but the surgeon has to be in the Tricare
network. The second question I would ask Tricare is who is the surgeon off
base, I would get the surgeons name and phone number and call there office
and find out about the waiting time for surgery. My surgeon required that
I attend a Weight Management Seminar, and then take a Psch test and see a
Pschcologist before I could get the first consult. The other poster is
correct, it is not Tricare that is requiring the nutritutionist it is your
pcp. That is the last question I would ask Tricare, can my pcp on base
require me to see a nutritutionist. Hope this helps
— cindy
July 4, 2003
I was at Ft Hood waiting almost a year and then because of deployemnts they
cancelled all gastro bypass surgeries. You can be referred to San Antiono
or other bases, Air Force too. I left in March and they were not approving
off base in my area at the time. I did have my psyc exam, 3 nutrition
classes, upper GI and blood work all at Ft. Hood but then started to go to
San Antonio to wait another few months there. San Antonio also required
addition testing. I had to come back to FL because mom has cancer.
Fortunately for me I had my surgery in FL May 15th. I was approved in 6
weeks for surgery. The only delay was my surgeon insisted on gallbladder
being removed and I had to appeal it two times. Other than that the
surgery was approved in a week. I hate to say it but if you are at a base
that requires surgery on base with long wait, go home and have it done by
civilian, its much faster. Feel free to email me any time
[email protected]
— Michelle S.
July 5, 2003
You may not be required to get approval from a nutritionist, but my
insurance did. Now that I am post-op this is what I am most thankful for.
As far as my surgery I sailed through with no complications. But, trying
to figure out what to eat, what not to eat, when to eat. It is all time
consuming. Be glad for what you can learn in the nutrition classes
required. This is what will determine how successfull the surgery will be.
This is life-long, not a quick fix. You really need to know this
information and the sooner you learn it the better off you will be.
— tonyapf
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