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Referrals for Specialty Care

If enrolled in one of the following TRICARE Prime options, you'll need a referral from your primary care manager (PCM) for most services that he or she can't provide, (see exceptions):

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

Your PCM works with your regional contractor for the referral. You may be referred to a military hospital or clinic for the specialty care.  

  • If you get care without a referral from your PCM, you're using the point-of-service option and will pay more out-of-pocket.
  • If enrolled in TRICARE Prime Remote, you may need to work with your contractor directly if you don't have an assigned network PCM.
  • If enrolled in the US Family Health Plan, you'll be referred to a specialist within your designated provider.

Beneficiaries using TRICARE Standard and Extra, TRICARE Standard Overseas, TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE For Life and TRICARE Young Adult-Standard Option will usually never need a referral for any type of care, but some 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 1/22/2015

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