TRICARE talks referals
By Brian P. Smith, TriWest Healthcare Alliance
/ Published March 09, 2011
BUCKLEY AIR FORCE BASE, Colo, -- How can TRICARE help you be healthy, wealthy and wise? In this article you will learn how to:
· Work with your primary care manager to keep your health in check
· Protect your wallet from unnecessary out-of-pocket expenses
· Make your specialty appointments more quickly.
It may start when your primary care manager (PCM) refers you to a provider outside of the military clinic for specialty care. Your PCM and the military clinic are your health partners. They help you manage your routine and specialty health care. TriWest gets the referral and then sends you an authorization for a number of visits within a certain time period for a specific type of care.
It is important that you know two things: how many visits and how long?
If you need additional visits - either more than were originally authorized or extending beyond the original time period - you will need to contact your PCM or the military clinic referral office. They may submit a new referral or may request that you visit your PCM.
If you see a specialist without a current referral in place, you would pay toward a deductible and then a 50 percent cost share. This is known as point of service (POS).
Active duty service members cannot use point of service. Without a referral, they may be responsible for the entire cost.
That's how you can save money. So how do you save time?
Easy! Register for paperless authorization letters at www.triwest.com/GoGreen. Don't wait days on a mailed authorization letter. Electronic notifications are sent within 24 hours of being processed. You can schedule your specialty care visits that much sooner