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”.