Referrals and Pre-Authorizations
A referral is when your Primary Care Manager (PCM) or provider sends you to another provider for care that they don’t provide.
A pre-authorization is when your care is approved by your regional contractor before you go to your appointment. If you are being referred, your provider will get you a referral and pre-authorization at the same time.
When care is approved:
Your regional contractor sends you an authorization letter with specific instructions.
You must:
-
Schedule your appointment with the provider listed in the authorization letter. If you need to find another provider, contact your regional contractor.
-
Get care before the authorization expires, otherwise, you’ll need to get the care re-approved.
Note: Active duty service members need a referral for most care received outside of the assigned military hospital or clinic.
What is Right of First Refusal?
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.
Looking to book an appointment online at a military hospital or clinic? Visit the
Secure Patient Portal for more information.
Service Point of Contact Information
- U.S. Coast Guard personnel should call the Coast Guard Benefits Line.