FAQ: How To Set Up A Follow Up With An Orthopedist Tricare Prime?

Can I go to any doctor with Tricare Prime?

A: If you’re an active duty service member (ADSM) or non-ADSM enrolled in a TRICARE Prime plan, then you need a referral from your PCM to seek most specialty care with another provider.

How long do Tricare referrals take?

“Once a request is placed by your provider, it can take up to ten business days before Tricare approves or denies the request.

Does Tricare Prime require a referral for a specialist?

TRICARE Prime requires referrals for specialist office visits and some diagnostic services (if you receive services that require a referral without obtaining one, you are using your Point of Service (POS) option). Your PCM works with Humana Military for the referral and authorization.

How do I get a Tricare Prime referral?

You need a referral from your primary care manager (PCM) for any care he/she doesn’t provide. This includes urgent, routine, preventive, and specialty care services. Your PCM works with your regional contractor for the referral and authorization.

What is the copay for Tricare Prime?

Cost shares and deductibles for Active Duty, Guard and Reserve Family Members:

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Tricare Prime Tricare Select
Primary Care Visit No cost Group A: $22 Group B: $15
Specialist No cost Group A: $34 Group B: $26
Ambulance No cost Group A: $70 Group B: $15
Emergency Room No cost Group A: $93 Group B: $42

What is the difference between Tricare Prime and Standard?

Under TRICARE Prime, specialty care must be referred by the PCM and will managed by the TRICARE contractor. Family members who choose not to enroll in Prime are covered under Standard. Under Standard, a PCM is not assigned and PCM referrals for specialty care are not required.

How do I check my Tricare referral status?

To view or check the status of a referral or authorization: Go to your regional contractor’s website. If not already registered for secure services, you’ll need to register first, then sign in.

How do I check my Tricare authorizations online?

Beneficiaries must log in at www. tricare -west.com to view authorizations, referrals and individual Explanation of Benefits statements. HNFS posts these documents electronically to the Secure Inbox where they can viewed online and/or printed.

Who is eligible for Tricare Select?

You can decide to use TRICARE Reserve Select if you’re: a member of the Selected Reserves, not on active duty orders or covered by the Transitional Assistance Management Program, and. not eligible for or enrolled in the FEHB.

How can I see a specialist without a referral?

PPO: You do not need a referral to see a specialist. However, some specialists will only see patients who are referred to them by a primary care doctor. And, some PPOs require that you get a prior approval for certain expensive services, such as MRIs. 4

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Do I need a referral for counseling Tricare?

You don’t need to get a referral or prior authorization for any outpatient mental health (except psychoanalysis) and substance use disorder (SUD) care. This includes services like therapy and counseling. If you choose a provider outside the network, you may pay higher costs.

Can urgent care do active duty?

Active Duty Family Member You don’t need a referral. You can get urgent care from any TRICARE authorized urgent care center or provider.

Can I use Tricare off base?

You can get the following services from a TRICARE network provider in your region without a PCM referral. If you get care from a non-network provider (or a network provider outside of your region) without a referral from your PCM, you’re using the point-of service-option, resulting in higher out-of -pocket costs.

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