Getting Specialty Care Just Got Easier

We’ve Updated Our Referral Process

We’ve updated our referral process to help you get the care you need with less confusion. These changes make it easier to see specialists and ensure our policies match TRICARE guidelines.

What This Means for You

If your specialist is IN NETWORK:

• Ask your primary care provider (PCP) to send a referral to the specialist and ask for a copy for yourself.  Health plan approval is not required.
• You will not be charged a Point-of-Service (POS) cost share when using in-network specialists, even if we don’t have a referral on file.

If your specialist is OUT OF NETWORK:

• Your PCP can ask the health plan to approve out-of-network care, but approval is only granted when the care is not available in network.
• If approved, you’ll pay your regular TRICARE Prime (US Family Health Plan) cost share.  
• You can still choose to go out-of-network without approval, but the claim will be processed under the Point of Service (POS) option, resulting in higher out-of-pocket costs. See “Point of Service”.

Before Your Appointment

1. Check if your specialist is in-network. Use the online Provider Directory.
2. Ask your PCP for a referral to help coordinate your care.
3. If no in-network option exists, your PCP must request prior approval from the Plan for you to see the out-of-network specialist at the standard TRICARE Prime member cost shares.

• Log in to the Member Portal to see if your PCP’s request was approved.
• We’ll also mail you a letter with our decision.

We’re committed to making your health care easier to navigate, so you can focus on what matters most.