Tricare Prime beneficiaries in the West Region should take note of a looming deadline for specialty care referrals to avoid paying out-of-pocket costs.
The deadline is Sept. 30 and applies to two types of referrals. This includes beneficiaries who have been receiving care under referrals issued during the special referral approval waiver period earlier this year. Those who used the waiver between Jan. 1 and June 30 and still need to continue seeing that specialist after Sept. 30 must obtain a new referral to a network specialist before Oct. 1, according to Tricare officials.
The second type of referral includes active referrals issued before Jan. 1 by the previous Tricare West Region contractor, Health Net Federal Services. These beneficiaries can continue to see the specialist listed on the referral through its expiration date or Sept. 30, whichever comes first.
Tricare Prime beneficiaries who require specialty care after Sept. 30 must contact their primary care manager to receive the new referral for their specialist. Starting Oct. 1, point-of-service fees may apply to those who see a specialist who isn’t in the Tricare network.
TriWest Healthcare Alliance, the West Region contractor, requires processing time to approve a new referral, so Defense Health Agency officials are encouraging beneficiaries to take action now.
The referral approval waivers were implemented earlier this year to help ease the problems families had been experiencing since TriWest took over the West Region contract at the start of the year. One issue was that Tricare Prime families hadn’t been able to get referrals approved by TriWest, which is traditionally required before Tricare Prime beneficiaries can receive specialty care.
“If you live in the West Region, it’s important that you take the time now to evaluate your current referrals,” said Jacob Sanchez, referral management subject expert for Tricare, in the Tricare announcement about the deadline. “Work with your primary care manager and plan ahead for specialty care you may need starting Oct. 1.”
Those who live in the East Region or overseas don’t need to take any action. Beneficiaries enrolled in Tricare Select plans usually don’t need a referral for specialty care.
