Healthcare referral in hand? Money in pocket

  • Published
  • By Brian P. Smith
  • TriWest Healthcare Alliance
How would you like to go to your next specialty healthcare appointment knowing that you were saving more than 50 percent?

One small step can save you money. What if it were as simple as making sure you had a referral?

The good news? It is that simple.

When your referral for specialty care is authorized and current, you can avoid paying an out of pocket deductible and 50 percent of the cost of the service.

When you're enrolled in TRICARE Prime, your care starts with your primary care manager. If you need care that they cannot provide, you will be referred to another provider for specialty care. The primary care manager submits the referral to TriWest Healthcare Alliance. TriWest authorizes the care and sends you a notification.

TRICARE Prime Referral Process
TriWest works with your primary care manager and specialty providers to get you the care you need through the TRICARE Prime referral process. TriWest supports all of your providers as they help you manage your healthcare.

If you don't have a referral, and you get services from a specialty care provider (not including emergency care), you could end up using the point of service option. This means you are responsible for 50 percent of the TRICARE-allowed amount for the care.

If you're an active duty service member, you'll always (except for emergencies) need a referral for civilian provider care. Without a referral, you could be responsible for the entire amount.

Referrals and authorizations do expire. If your primary care manager submitted a referral for you in the past, check to make sure your referral is still valid. You can see your current referrals and authorizations in your secure TriWest.com account.

Check in With Your PCM
Has it been a while since you've visited your primary care manager? Check your TriWest.com account to find their name, location and contact information.

Don't have a TriWest.com account yet? Sign up today on TriWest.com. You can view your referrals and sign up to get text or email alerts when an authorization is processed. You'll know that your care is authorized in hours instead of days. That means you can get your care soon.

What do you need to save time and money before your next visit to a specialty provider? Your referral. Get it faster at TriWest.com.