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.