[HEALTH.MIL] Specialty Care Referrals

  • From: HEALTH.MIL@xxxxxxxxxxxxx
  • To: <HEALTH.MIL@xxxxxxxxxxxxx>
  • Date: Thu, 22 Oct 2015 11:35:06 -0500

Specialty Care Referrals


Many TRICARE Prime beneficiaries receive primary care from providers in military
hospitals and clinics. Occasionally, they may need to receive specialty care.
When this happens, they must receive a referral from their primary care manager

Getting a referral makes sure your regional or overseas contractor authorizes
the care before you make an appointment. TRICARE rules require that if the care
you need is available at a military hospital or clinic near you, and there is
space available, you will be referred there first. Military hospitals and
clinics have 90 minutes to accept urgent referrals and two business days to
accept referrals for routine care. If your local military hospital or clinic
does not accept the referral within that time, you will be referred to a network
provider near you.

Your regional contractor will send a letter with the name and location of your
specialty provider. The letter will also tell you what care is authorized, the
length of time you are authorized to receive that care, and the type and number
of visits you are allowed before you need another referral.

Before making an appointment with the specialty care provider,
<http://www.tricare.mil/callus> call your regional contractor 3-5 days after the
PCM enters the referral to check the status. Try to take copies of your medical
records, x-rays and lab results with you to see the specialist.

If you are overseas and are referred to a host nation provider, be sure to
coordinate your care through your
<http://www.tricare.mil/Plans/Enroll/TPO.aspx> overseas contractor.

SOURCE: TRICARE News Release at http://www.tricare.mil/rofr102215

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