Right of First Refusal

The Right of First Refusal process allows the military hospital or clinic to provide specialty careSpecialized medical/surgical diagnosis, treatment, or services a primary care provider isn’t qualified to provide. to those with TRICARE Prime.

What Should I Know About Right of First Refusal?

Right of First Refusal applies only if you have TRICARE Prime.

• You must live within a 60-minute drive of a military hospital or clinic or you can waive the drive-time standards to stay enrolled in TRICARE Prime.
• During TRICARE Open Season, you can switch to TRICARE Select; this plan doesn’t require Right of First Refusal.
• There is no copaymentA fixed dollar amount you may pay for a covered health care service or drug. for care received at a military hospital or clinic.
• TRICARE East can’t change the facility that accepts a referral; only the military hospital or clinic can do that.

Reversals are allowed for these reasons:

• Continuity of care
• Special circumstances that prevent you from using a military hospital or clinic

If a provider determines you need specialty care, they’ll submit a referral request to TRICARE East. Often, the military hospital or clinic has the specialized services available; and they’ll notify TRICARE East, usually within one business day. Then, TRICARE East will refer you to that military hospital or clinic.

The facility may contact you to schedule an appointment. Then, TRICARE East will give you the details about that facility. If they can’t provide the services, you’ll be referred to a civilian network provider.

If you choose a provider before the Right of First Refusal decision, and the military facility can provide the services, you must go to the military facility instead.