TRICARE: Process for Care Authorizations and Tips for Traveling, Moving
TRICARE Prime, your military health care plan, travels with you as you travel from region to region, but there are certain things you should know before seeking care while away from your primary care provider.
If you have a medical emergency while traveling, go to the nearest emergency room. Authorizations are not required for emergencies; however, you should keep all receipts and paperwork for your records and contact your primary care provider within 24 hours of receiving care. This will ensure proper and quick payment. For more information, contact Humana-Military Healthcare.
An emergency is a medical or psychiatric condition that would lead a prudent, non-medical person to believe the lack of immediate medical attention would threaten life, limb or sight. In these cases, emergency care is also appropriate to relieve severe pain or suffering.
Examples of emergency conditions include, but are not limited to loss of consciousness, shortness of breath, chest pain, heart attacks, uncontrolled bleeding, sudden weakness or paralysis, poisoning or suicide attempts. Normal labor and delivery of a child after the 34th week of pregnancy is not considered an emergency and delivery at a civilian hospital after this time can result in additional charges.
If you need to see a provider for an urgent medical problem (office visit) that cannot wait until you return from your travel, you must first make sure that the provider you select will accept TRICARE. Ask the provider to fax a consult sheet with information on the reason for your visit to area code (254) 553-1819 (Carl R. Darnall Army Medical Center Referral Management Center). The Referral Management Center will process the consult and fax an authorization back to the provider on the next business day.
If proper authorization is not sought for urgent care, you will be billed under the Point-of-Service option, resulting in higher costs to you. It is also recommended that you notify your primary care provider to let them know that you have seen another physician soon after you have received care. Examples of urgent conditions include, but are not limited to, sprains, colds, earaches, sore throats, and a rising temperature.
Routine is not authorized while traveling. Please visit your primary care provider upon your return.
If you need medical care while traveling in a foreign country with a U.S. Military Treatment Facility seek care at that facility if it is conveniently located or contact the Health Benefits Advisor at that MTF for their assistance in locating nearby providers of care.
If you are traveling in a country without a U.S. MTF, contact the nearest U.S. consular office for their recommendations on nearby providers of care or seek care at a local hospital or clinic and notify the HCF as soon as possible.
Prescriptions While Traveling
When traveling outside your TRICARE Prime area, make certain you bring along enough of your prescription to last the entire trip. If you have to fill the a prescription while outside your TRICARE region, you will have the pay the entire amount out of your own pocket and then seek reimbursement from TRICARE when you return home.
When you are traveling within your TRICARE region, you pay only the co-payment by using a network pharmacy.
PCS and Prime
If you are making a permanent change of station (PCS) to another military installation, active duty service members and their family do not have to disenroll from TRICARE Prime.
Active duty service members will transfer their enrollment when they in-process at their new duty station. Upon arrival at the new duty station family members can visit the TRICARE Service Center to update their information and transfer their enrollment.
The Fort Hood TRICARE Service Center, located in building 36023, across the parking lot from Carl R. Darnall Army Medical Center, can provide you with travel brochures that answer your questions about traveling or moving with TRICARE. To find out more, please call a health benefits advisor at 288-8155. The TRICARE Service Center is open Monday through Friday, 7:30 a.m. to 5 p.m.
Taking TRICARE to College
If you have children who will be attending college this fall, TRICARE Prime makes it easy and inexpensive for them to receive the health care they need away from home. Here are some steps you can take to ensure that TRICARE goes to college with your child:
- Verify registration in DEERS and TRICARE Eligibility: Make sure your child is properly registered in DEERS by calling 1-800-444-5445 or 1-800-538-9552. To be eligible for TRICARE, unmarried children must be under the age of 21; or age 23 if they are full-time college students.
- Determine What Plans Are Offered in the Area of Your Child's College: It is important to determine if the area where your child attends college offers TRICARE Prime. If TRICARE Prime is available, you will need to pick a new Primary Care Manager as soon as possible. Contact the TRICARE Service Center to obtain a PCM request before going to college. If TRICARE Prime is not offered, he or she may still use TRICARE Standard or Extra benefits after disenrolling from Prime.
- Transferring Enrollment Back Home for the Summer: If you child returns home for the summer, his or her enrollment will return also. If your child is traveling back and forth frequently, TRICARE Standard may be the best plan. It has greater flexibility than TRICARE Prime.
- Calling for Pre-Authorizations Avoids Higher Point of Services Charges: If your child is enrolled in TRICARE Prime, make certain that he or she understands that pre-authorizations are needed for all health care except emergency care. Your child's PCM will usually arrange for any necessary pre-authorization. If the PCM is not available, he or she will need to contact a Health Care Finder by calling 1-800-444-5445. If pre-authorization is not obtained, you will be subject to Point-of-Service charges, which can be significantly higher. This rule may apply even to the student medical clinic at the college.
If you have any questions about taking TRICARE to college, please visit the TRICARE Service Center located in building 36023, across the parking lot from Carl R. Darnall Army Medical Center. The center is open from Monday through Friday 7:30 a.m. to 5 p.m. A health benefits advisor can be reached at 288-8155 or 1-800-444-5445. More information about TRICARE can be obtained at the website, www.tricare.osd.mil.
page last modified on: 5/7/2013