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..

This includes specialized medical and 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 is a requirement under TRICARE Prime. It applies only if you have TRICARE Prime.

• You must also live within a 60-minute drive of a military hospital or clinic, or if you waived access standards to stay enrolled in TRICARE Prime.
• During TRICARE Open Season, if you have TRICARE Prime you can switch to TRICARE Select, which 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.
• If the military hospital or clinic accepts your referral under the Right of First Refusal, TRICARE West can’t change it; only the military hospital or clinic can do that for you.

There are two reasons Right of First Refusal can be reversed:

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

When a provider determines you need specialty care, they’ll submit a referral request to TRICARE West for approval. The approval process includes Right of First Refusal processing. Often, the military hospital or clinic has the specialized services you need. If this is true for your situation, they’ll notify TRICARE West, usually within one business day. You’ll then receive a referral to that military hospital or clinic.

The facility may reach out to you to set up an appointment. At that time, TRICARE West will share information about that facility with you. If they can’t provide the services you need, you’ll get a referral 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.