[MILKMAMMA]

Just wanted to say Hi and introduce myself. I'm just starting the process for approval to have Gastric Bypass. I went to my PCM and received a referral to University of Miami for a Bariatric Surgery Consult.

My Insurance company (Tricare Prime Remote) sent me to Dr. Nestor de la Cruz-Munoz. I attended his Seminar on 11/24/2009

When talking to his Insurance staff after the Seminar I was informed they do not accept Tricare in any shape or form. I'm a little overwhelmed but I know this is something I must do for myself.

I called Tricare today and they seem unable to find a Bariatric Surgeon that accepts Tricare Prime Remote in my area.

Does anyone here have Tricare and the name of a Surgeon they have used in Miami.


Thanks in advance!
Elle

[DocSanae]

Welcome to the board, thank you for joining us.
Good luck with your process.
(((((HUGS))))) May your journey go well.

[MsVickie]

For one thing what they told you was WRONG. LOL Unless the physican dont accept Medicare also. You see its a govement funded heath care system. They dont have to be a participating provider with Tricare but they must accept it and take the payment for 70 percent of all covered charges. Yes in the end it will cost you more but they have to take it. They can request however what they feel the bill will be upfront after Tricare takes care of it. Just remember that part. They all have to accept it but they dont have to particpate with it.

I have Tricare standard. There would have to be a hosptial within reasonable distance that accepts Tricare Prime. Yes that is not exactly the policy you have but if the hosptial takes the prime then with your other Tricare plan they will accept it as if you had prime meaning they pay more. Do you have a HCA facility near buy within a couple hours drive? You may have to drive further than that but there is someone that will accept it. You being in FLA and as many bases they have down there there are surgeons somewhere that will accept it.

Go on the Tricare site and look near Homestead and see if there is a hosptial in network with Tricare. You may have to look more than 100 miles from you current residence but you will find somone.

Its a mess I know but it can be found. Remember if any of them accept Medicare they have to accept Tricare. But they only have to accept 70 percent of allowable charges. If you find one that is in network with Tricare your much better off. Either way you can have this done. Trust me I went though all this when I married my husband. At the time he had Tricare Prime and I had standard. He could see our local physican because he had prime and was grandfathered in under a old law. Me.... not so lucky.

[MILKMAMMA]

Originally Posted by MsVickie

For one thing what they told you was WRONG. LOL Unless the physican dont accept Medicare also. You see its a govement funded heath care system. They dont have to be a participating provider with Tricare but they must accept it and take the payment for 70 percent of all covered charges. Yes in the end it will cost you more but they have to take it. They can request however what they feel the bill will be upfront after Tricare takes care of it. Just remember that part. They all have to accept it but they dont have to particpate with it.

I have Tricare standard. There would have to be a hosptial within reasonable distance that accepts Tricare Prime. Yes that is not exactly the policy you have but if the hosptial takes the prime then with your other Tricare plan they will accept it as if you had prime meaning they pay more. Do you have a HCA facility near buy within a couple hours drive? You may have to drive further than that but there is someone that will accept it. You being in FLA and as many bases they have down there there are surgeons somewhere that will accept it.

Go on the Tricare site and look near Homestead and see if there is a hosptial in network with Tricare. You may have to look more than 100 miles from you current residence but you will find somone.

Its a mess I know but it can be found. Remember if any of them accept Medicare they have to accept Tricare. But they only have to accept 70 percent of allowable charges. If you find one that is in network with Tricare your much better off. Either way you can have this done. Trust me I went though all this when I married my husband. At the time he had Tricare Prime and I had standard. He could see our local physican because he had prime and was grandfathered in under a old law. Me.... not so lucky.

Thank you! The University of Miami is in network for me, so that's ideal. The problem I'm having is finding a Bariatric Surgeon who uses UofM and is also in network. I've considered switching to Standard, and I definitely haven't ruled that out yet. The Insurance gal at Dr. Nestor de la Cruz-Munoz office was extremely rude when I called again to inquire about them accepting Tricare and when I asked her again to double check she hung up on me.
I'm going to call back again Monday and get to the bottom of it. I also found another Surgeon who is on the UofM website who is listed as a Bariatric Surgeon with great credentials, I just have to call Monday and find out if they are in network for Tricare Prime Remote. So confusing!!

Thanks again!!
Elle