Ever since the government reneged on its pledge to provide the military with free medical care, the military health system has been in transition. Now run more like the PPO’s with which many Americans are saddled, the military system has as many flaws as it has benefits. Medical care on base is often limited and left to physician’s assistants and/or civilian doctors without successful outside practices. Obtaining a medical referral for a more serious condition such as a heart attack, a stroke, or cancer can be a trying process if one doesn’t understand how the system works.
Instructions
1. Compose a list of the symptoms and concerns for which you want a referral. It is imperative to provide the military physician with as much information as possible about the disease or condition.
2. Make an appointment with the assigned primary care facilitator (PCF). This must be done through the military facility to which the patient is assigned. Go over the list of symptoms and concerns with the PCF. He will then decide whether or not a referral is called for. If so, the PCF will request a TriCare referral.
3. Call the TriCare referral desk within two to five days. If the referral has been processed, the TriCare representative will provide information about the civilian care provider to which the referral has been made. They will outline the number of approved office visits and the time frame allowed. It will also list any care restrictions.
4. Read the paperwork sent out by TriCare. It will reinforce all of the necessary information outlined in Step 2 above. It is generally received within one to two weeks. The papers may also provide additional information. Check to make certain that the paperwork has been forwarded to the PCF. Otherwise, his or her facility may fight against payment for any or all referral office visits.
5. Make an appointment with the specialty care provider assigned by TriCare. The patient rarely has control over who he or she is assigned to. The decision is made by TriCare from a list of pre-approved civilian providers who are willing to accept TriCare’s reduced payments. The assigned provider is the only one that the patient is authorized to see. If the patient isn’t happy with the decision, he or she must contact the TriCare office to request another provider. Such a request may or may not be approved based upon the decisions made by the TriCare office.
6. Attend the approved appointment. The civilian provider will work with the patient within the restrictions of TriCare. If additional testing, surgery, physical therapy or other work is required, the care provider will notify TriCare of those needs. If the office approves the requests, new paperwork will be issued to that effect. If the office denies the requests, the patient must decide whether to pay for the continued health care on his or her own or conform to TriCare rules and regulations as outlined.
7. Follow up the last civilian appointment with the patient’s military primary care provider. He or she will then determine if additional assistance is required. A determination will be made whether or not such assistance can be handled on base or if additional TriCare referrals will be required. If so, the process stars over again with Step 3 above.
8. Report any unsatisfactory medical treatment on or off base to the base’s medical commander. He or she will then decide proceed.
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