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Referrals for Specialty Care

Active Duty Service Members

You must have a referral from your primary care manager (PCM) for all preventive, mental health or specialty care services.

  • Your PCM refers you to a specialist and works with your regional contractor for the referral.
  • Your contractor will try to refer you to a military hospital or clinic first.
  • If not available, you're referred to a network provider in your region.

You can’t get any type of care without seeing your PCM first. If you do, you may be responsible to pay for the care out-of-pocket.

All Other Beneficiaries Enrolled in a TRICARE Prime Plan

You should get a referral from your PCM for most services that he or she can't provide. (See Exceptions)

  • Your PCM refers you to a specialist and works with your regional contractor for the referral.
  • Your contractor will try to refer you to a military hospital or clinic first.
  • If not available, you'll be referred to a network provider in your region.

If you see a specialist without a referral from your PCM, you’re using the point-of-service option and will pay more out-of-pocket.

  • Enrolled in TRICARE Prime Remote? Work with your regional contractor if you don't have an assigned PCM.
  • Enrolled in the US Family Health Plan? You'll get a referral to a specialist within your designated provider.
  • Enrolled overseas? Call your regional call center.

The TRICARE Prime plans include:

  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas
  • TRICARE Young Adult-Prime Option
  • US Family Health Plan

All Other Beneficiaries

Are you using any of the following plans?

  • TRICARE Standard and Extra
  • TRICARE Standard Overseas
  • TRICARE Reserve Select
  • TRICARE Retired Reserve
  • TRICARE For Life
  • TRICARE Young Adult-Standard

You don’t need a referral for any type of care except Applied Behavioral Analysis. Other services may require prior authorization.

Always try to see a network provider first!

Network providers can't:

  • Ask you to sign a document to make you pay for authorized services.
  • Ask you to sign a document to make you pay for any part of the service not covered by TRICARE.
  • Refuse to see you because you won’t sign such a document.

>>Learn More

Last Updated 7/1/2015

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