A referral is when your primary care manager sends you to see another provider. If your PCM refers you to a civilian provider, you can find your referral in your TRICARE regional contractor’s online patient portal or by phone. ()
FALLS CHURCH, Va. – If you have a TRICARE PrimeOpens tricare.mil plan, referrals play a big role in how you get health care. A referralOpens tricare.mil is when your primary care manager sends you to see another provider. If your PCM needs to refer you to a civilian provider, your TRICARE regional contractorOpens tricare.mil also plays a role in the referral process.
“When you need a referral to get civilian care, your PCM sends a request to your regional contractor for review,” said Tonya Utterback, referral management expert with the TRICARE Health Plan at the Defense Health Agency. “Once your regional contractor approves the request, you’ll get an electronic authorization letter with instructions for using your referral.”
Read on to learn tips for finding and using your referrals.
Where to find your referral
It typically takes three business days for your contractor to process your referral. To check its status or download your authorization letter, go to your regional contractor’s patient portal. If you don’t already have an account for your region’s portal, you’ll need to create one.
Stateside: Log in to the TRICARE East Region patient portalOpens humana-military.com or TRICARE West Region patient portalOpens tricare-west.com.
Overseas: Log in with the MyCare Overseas mobile appOpens tricare-overseas.com or web-based portalOpens TRICARE Overseas portal.
You can also get information about your referral by phone.
East Region: Call 800-444-5445.
West Region: Call 844-866-9378.
Overseas: Call your TRICARE Overseas Program Regional Call CenterOpens tricare-overseas.com.
What to do with your referral
Your authorization letter will outline the care and number of visits you’re approved for. It will also have information about the provider you’re referred to. Contact that provider to schedule your first appointment. If you want to see a different provider, call your regional contractor.
Don’t forget to check the letter for your referral’s expiration date. Most referrals expire in 180 or 365 days. If your referral expires and you need a new one, contact your PCM.
When you need a referral
Do you need a referral? It depends on your beneficiary categoryOpens tricare.mil, health planOpens tricare.mil, and the type of care you need:
Active duty service members: You need a referral for any medical care your PCM doesn’t provide. If you get care without a referral, you may have to pay out of pocket.
All others with a TRICARE Prime plan: You need a referral for specialty care and some diagnostic services. If you get this care without a referral, you’ll be using the point-of-service optionOpens tricare.mil. You’ll pay more out of pocket if you use this option, as outlined in the TRICARE Costs and Fees Fact SheetOpens tricare.mil.
TRICARE Select, TRICARE Reserve Select, TRICARE Retired Reserve, and TRICARE For LifeMedicare-wraparound coverage for TRICARE-eligible beneficiaires who have both Medicare Part A and B.TRICARE For Life: You don’t need a referral for most health care services.
To learn more about referrals, check out Referrals and Pre-AuthorizationsOpens tricare.mil and “Q&A: Getting and Using Referrals With TRICAREOpens tricare.mil.” To learn how to make an appointment with your PCM, go to Book AppointmentsOpens tricare.mil.
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