Whom do I call for information about benefits, authorization, and referrals?
Call VALUOPTIONS, 1-800-700-8646.
I am enrolled in Prime. Do I need a referral from my Primary Care Manager (PCM) to see a network mental health provider?
Any TRICARE beneficiary can self-refer for the initial 8 outpatient mental health visits without a PCM referral. Call VALUOPTIONS with any questions or for the names of network providers in your areas. You can also obtain a current provider list from the Tricare Service Center.
What is the "Point of Service" Option?
As a Prime enrollee, you have the option of going outside the network for your mental health care, but it's very expensive. You would have to pay a deductible ($300 individual or $600 family) and 50% of the cost of the care.
What is the difference between Prime, Extra and Standard?
Standard is the same as CHAMPUS before the other TRICARE options were added. Extra is a Standard beneficiary (not enrolled in Prime) who chooses a network provider for care. So, if you want to be in Prime you must be enrolled and choose (Or are assigned) a PCM to coordinate your care. You also have a "network" of providers who have agreed to treat Prime patients.
What do I do if we have a need for emergency care?
Simply go to the nearest hospital for assistance. A NAS (non-availability statement) is not required for emergency care. We ask that the hospital contact VALUOPTIONS, preferably within the first 24 hours.
What requires a NAS in mental health?
Standard beneficiaries who reside within a 40-mile radius of Carl R. Darnall Army Medical Center (CRDAMC) and require non-emergency INPATIENT mental health care must obtain a NAS. Prime enrollees are not required to obtain a NAS. Prime enrollees electing to use the Point of Service option will require a NAS.
What is my cost when I go to a civilian provider for an office visit?
Your cost depends on whether you are enrolled in Prime, your sponsor's rank and status, and whether you choose a network or non-network provider.
| MENTAL HEALTH OFFICE VISIT COSTS | ||
|---|---|---|
| Active Duty family members: (individual) | ||
| E-4 and below | Prime | $0 |
| Extra | 15% of contract fee | |
| Standard | 20% of allowed fee | |
| E-5 and above | Prime | $0 |
| Extra | 15% of contract fee | |
| Standard | 20% of allowed fee | |
| Retirees and other: | Prime | $25 |
| Extra | 20% of contract fee | |
| Standard | 25% of allowed fee | |
REMEMBER: Standard and Extra beneficiaries must pay an annual outpatient deductible.
Who has to obtain treatment authorizations?
Your provider or facility is responsible for obtaining approval from VALUOPTIONS.
FOR MORE INFORMATION, PLEASE CALL
1-800-700-8646 or visit TRICARE Website.
page last modified on: 5/17/2013