TriCare Prime

Military Providers

If military members and their dependents covered by TriCare Prime reside near a military medical facility, they are expected to seek care there. These medical facilities work similarly to a Health Maintenance Organization (HMO) in the sense that patients do not necessarily see the same doctor each visit, and they also need to receive referrals from their doctor before getting specialized care.

Military medical facilities vary in their offerings, but most are capable of providing care similar to civilian organizations. Services include:

• Urgent Care Facilities
• Family Medicine and Pediatrics
• Radiology and Laboratories
• Physical Therapy
• Many other offerings, depending on location

Some of the clinics in military medical installations are not available to family members, but instead solely serve the active duty members. Additionally, military members who perform sensitive duties may be limited in the types of medication and other medicinal therapies they are allowed to utilize while still maintaining their occupational status.

Civilian Providers

When TriCare Prime recipients need to visit a doctor or other medical facility which is not affiliated with the military they must first obtain a referral from their primary military doctor. The referral must then be approved by a TriCare representative, who will then mail a referral approval letter to the patient. TriCare Prime recipients are referred to civilian providers when they aren't able to receive the specialized care they need at the military hospital, either because of lack of military providers or the lack of facilities.

In many cases, recipients with an approved referral can visit a civilian provider with no out-of-pocket expense or deductible, and co-payments on prescription drugs filled at civilian pharmacies are relatively low. Military installations equipped with pharmacies can fill prescriptions from civilian providers at no cost to the patient.

TriCare Prime recipients should not expect to be approved for alternative medicine therapies, such as massage therapy and acupuncture. Medical procedure such as cosmetic surgery are not usually approved either.

TriCare Prime Emergency Care

Although recipients are required to obtain approval to seek care through civilian providers, emergency care does not necessarily require pre-approval. Military members and their families who experience life-threatening injuries or other emergency situations are urged to visit the emergency room which is closest to them, whether that happens to be a military facility or a civilian facility. In fact, many military installations are phasing out emergency room facilities altogether, and instead merely offer urgent care facilities which are oftentimes open only limited hours. TriCare Prime beneficiaries, however, must be sure to notify their local TriCare office as soon as possible if emergency room care was needed. If the emergency room visit is deemed unnecessary by a TriCare representative, the patient may be billed for the cost of the care.

Reservists and National Guard

Active duty military members and their families aren't the only people eligible for TriCare Prime. When military reservists and national guardsmen are called to duty they are eligible to use the military medical facilities, including the TriCare dental facilities.

TriCare Prime Customer Service

Most military medical facilities have a TriCare administrative office on-site. The personnel in these offices can answer questions in addition to assisting with enrollment and un-enrollment procedures. There is also a user-friendly website in addition to a toll-free number accessible to personnel serving overseas. Although the TriCare customer service department is not necessarily renowned as a customer service leader in the health care industry, they are generally prompt, polite, and knowledgeable.

In conclusion, TriCare offers suitable medical insurance to military members and their families. Most service members find the coverage more than acceptable.