You need a referral from your primary care manager (PCM) for any care he/she doesn't provide. This includes urgent, routine, preventive, and specialty care services.
You can’t get any care without seeing your PCM first. If you do, you may be responsible to pay for the care out-of-pocket.
If you see a specialist without a referral from your PCM, you’re using the point-of-service option.
This is when your regional contractor refers you to a military hospital or clinic first. The military facility has the right to take the referral or refuse it. If they refuse it, then you'll get a referral to a network provider.
Health Net Federal Services and Humana Military are honoring authorizations and referrals issued by the previous TRICARE contractors through their 2018 expiration dates. There is no action needed for these already-approved requests. If your referral or authorization expired prior to 1/1/18, your provider can submit updated requests to your new TRICARE contractor.
You should try to see network providers instead of non-network providers. Network providers can't:
Last Updated 6/5/2018
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