[MsVickie]

OK people this is a new one to add to the list of what is a matter with insurance company's and this surgery.

I have told yall many times I have TRICARE. Its a military insurance. Im not supposed to have any problems with them and they will pay for the surgery. However let me tell you what my little mess was.

Seen my second surgeon on March 30th. They told me they would send his typed notes to my insurance company in 7 days once they got the transcription back. This is normal. My insurance company is a fast working company. Once they receive a request they have 72 hours to act on it.

So I waited 2 weeks. Called the insurance company to make sure they had received records. No mam We have not received anything yet. I was like mmmmm. So now you know Im gonna call the surgeons office. I did so. Charlene (nice country name), told me yes mam I sent the records on April 5th to be exact. I said OK honey I will let them know you did send them. She said OK but to be on the safe side.... I will send them again. So she did. I waited a week......mmm nothing. So I call the insurance company up every day for 5 days straight.

No mam no records yet.......Knowing Charlene on a bit of a personal level....I knew she had sent them. So on the 6th day......I got blessed to get a young man on the phone who seemed to think something looked funny to him. However he couldn't help me but he would tell medical management something wasn't right. So I waited....Ladies in medical management come on.

Well i have no idea but the gentleman that sent you to talk to me seems to think something is wrong. Let me dig down a bit. Can you wait? Oh yes mam Im gonna wait all day if need be. So she comes back. Seems they stated this: They sent in a records but they put them under your your number instead his. They couldn't match me up. I said HUH????How are we gonna fix this? She said well mam.......(gotta love the mam part dint ya.)....They need to send them again......... but under your hubby's number not yours..... I said listen...how dam hard can it be to just attach them to the matter at hand. You state you got them...... but need them sent again? I got MY way. You have to stay on them. They have to record every call made. They know when you called last.

Now I got a NUT appointment on April 30th. That is a mile stone. LOL

I have to do one blood test...H Pilori....checking for stomach ulcers. They submit...and this time they will have no excuse. I will tell you know.....if I didn't have the job I do.........( sitting on the phone almost all day to get test approved) I would have no idea what to do. Im worth this surgery and I be damed if a insurance company is gonna deny me.

We are gonna have to make a list of stupid excuses why insurance compnays wont pay.

[fr1endly2]

((((HUG)))))) for your ordeal
how stressful! BUT glad
your being your own advocate
and staying on top of things
hugs

[bren]

MsVickie, make sure when you start having procedures done that everything is being submitted under hubby's SSN or they won't pay either. I had that happen with a follow up surgery for a stricture and took a little while to get straightened out!!

[MsVickie]

Yep I know. The part that killed me what the fact they had them but wasnt gonna put them were they needed to be placed. They asked they be sent again 3rd time. They scan all this into the system. Under my SS# they had them. They just wasnt about to transfer them under my hubbys. After a few eliqent words they managed to click that button they needed to and fix it. LOL.

[NettiePooh]

Hey, Ms Vickie... go figure.... my daughter-in-law has Tricare and she up and decided she wanted GBS in March. She is scheduled on the same exact day I am.... May 7th!! And, I am NOT kidding you, she does not appear to be that obese! In fact, I figured Tricare would deny surgery and have her placed in a weight management program. She may have other co-morbidities I am not aware of. Good luck to you and the powers-that-be!! Bear in mind when we fax records to Tricare, they all go to a central fax unit and then are dispursed (or misplaced) from there. In my office we keep EVERY confirmation on our Tricare patients because then individual office is kept accountable for the records. I ALWAYS state in my quarterly meetings with Tricare they need to keep themselves accountable.....

[MsVickie]

Hi there Nettie. Your date is comming up fast. Im excited for you girly. Tricare is easy to work with yes. And i never thought I would have trouble with them but I had my first instance. Yes Nettie I sometimes wonder.... if the heavier people dont have a tougher time getting this done. You would think they would be the ones not having a bit of trouble but I think sometimes that its backwards. Im a insurance growler anyways. I will keep a journal on this so mabye it can help others in the long run. I know one thing.....My insurance company will know my name well until its approved! LOL. Hey im the only one that can fight for me and I will do it. And Nettie honey you have had to go through alot just to get were you are now. Im glad your surgery is a go. You keep us informed girly. Take care

[mike]

Don't you just love those insurance companies? A person has to constantly keep on them, so everything keeps moving. You shouldn't have to, but you do always get the same answer. We are working on it. YAH RIGHT. I am glad to hear though, that you are not just sitting back. You are giving them constant nudges. WAY TO GO! Keep us posted.
mike

[Spikey1341]

If you want my experince with Tricare I say they suck! Everytime a claim is submitted something is wrong. They are famous for saying they never got it. I had a friend who decided to send the info certified mail so she would have a signature. Do you know what they told her? They don't sign for the mail, the US Post Office does. They get too much mail every day to sign. She checked and it was rubber stamped. She was going to call the post office in St. Louis to see if this was the case.

I also have BCBS. When the military insurance was Champus, I never paid anything out of pocket. What my primary didn't cover Champus did. Now I get letters from Tricare stating that my primary insurance covered so much, let's say $80. The procedure cost $120, so I have $40 left to pay. Since Tricare would have only covered $75 and BCBS covered $80 they won't pay anything.

I was going to drop my husband from BCBS and have him go strictly with Tricare. I was told not to, because if he got seriously ill I could end up spending a lot of money out of pocket. This is what he gets for making a career out of the Army and retiring.

Sorry for the rant, but Tricare really chaps my butt!

[beckamarie]

Vickie, I had the EXACT same thing happen to me with tricare. Luckily I have a great Dr. and she now doubles everything. She now makes sure its under hubbys ssn and not mine. I am glad you got straight with them

[MsVickie]

Yep I got it straight. LOL just like any other insurance company you have to stay on them and let them know your not gonna just sit and wait. I report all this in hopes its gonna help someone one day. As I always say we have to stand up for our selfs !

Spikey: LOL I hear you honey. When my married my hubby I dropped my BC BS policy because of the same thing you are going through. I would have had to run it thought BC BS then to TRICARE. I first thought OK great 2 policy's but then.....I called and questioned them dearly on this. I would have to pay for the Prescriptions through my BC BS policy. My copays were 10 /30/50 and then 20% of the cost of the meds This is with a 150.00 per year deductible on just meds.

The health benefit was 1,200 a year this was the deductible. Then I would have to personally send them to TRICARE hoping it might pay something. And get into the mess you have of making them pay the rest of a Dr Bill which you have found is not easy.

This is what i did. I went from paying $210.00 per month insurance premiums just for me out of my paycheck . My company picked up 75% of my premium and that was what i was left monthly to pay. I was on $230.00 worth of meds each month. When I moved over to just TRICARE it went down just for me down to ....... No copay. Use in network Dr's and facility's. Now my meds are all Mail ordered through Expresscripts. I pay a total of $27.00 total for 3 months supply. 3 bucks for the generic and 9 bucks for name brand. I have also found they didn't carry some of the generic brands to which they will still only charge me 3 bucks for 3 months. I can still go to my local pharmacy and get them but I have to pay either 3 or 9 for just 30 days.

Now if you in a TRICARE Prime area you have it made. Let me explain. You might have to pay a small monthly premium I think my hubby's is 19.66 a month but you get the prescriptions the same amount I do. If you have inpatient surgery such as this Gastric Bypass you pay a grand total...are you ready for this of $25.00 Yes only 25 dollars. The surgeon is totally paid for. No copay to him what so ever. The reason I know this is .....my hubby just had Thyroid Cancer last year in June. He had it taken out....... and stayed in the hospital for 3 days. That $25.00 copay would have covered a month.The surgeon was totally paid off 100%. He has prime. I have standard. Trust me I tried to get on prime. Every time you see the Dr its only 12 bucks. You get a CT Scan MRI PET radiation treatments its 12 bucks a piece. Now me as long as I go to what they call in network I get a huge discount and pay sometimes less than he does for routine visits like med checks. Unless its for a Major test like a CT scan. I paid for my last one CT Scan a couple months ago $21.80. You do have a great benefit Spikey honey. The only way you will see it is if you drop yours and go on his. Scary I know but I did it and dam I wouldn't go back for nothing.

The only reason Im not on prime is because I dont live in what they call a prime area. SUCKS!!!! But Mike was grandfathered under it. Go to mytricare.com and see if your in the prime area. I would check into this if you want to. we counted it up and I personally saved over 4,500 a year just using TRICARE. But like any insurance company watch them close.