This article discusses the flexibility you have in Choosing a Desirable Doctor based on which TRICARE health care plan you have.
The kind of doctor or health care provider (that is, any doctor, nurse, physician, medical facility or hospital) that you can see depends on the type of TRICARE health care plan you have.
Furthermore, how you can Choosing a Desirable Doctor and book an appointment with a doctor also depends on the health care plan that you are using.
Choosing a Desirable Doctor based on TRICARE health care plan
If you are using a Tricare Prime plan, then you will first have to get in touch with your primary care manager. The primary care manager will then book an appointment on your behalf. If your primary care manager is located at a military clinic or hospital, then you can book an appointment with your doctor online. In certain cases, you may need to see a specialist doctor. The primary care manager will be the one who will refer you to a specialist doctor. If you consult a specialist doctor without first obtaining an authorized referral from your primary care manager, then it will be considered to be a point-of-service visit.
In the TRICARE Standard plan, you have the option of booking an appointment with any doctor who is authorized by TRICARE as a TRICARE provider. Under this particular plan, you do not need to get a referral from your primary care manager if you have to consult a specialist doctor. However, even then, there are certain services for which you will need to get authorization from the primary care manager. In addition to this, military clinics and hospitals can also provide you with medical assistance, given that there is enough space available.
If you have enrolled for the TRICARE Reserve Select plan or the TRICARE Retired Reserve plan, you can book an appointment with any doctor who is authorized as a TRICARE provider. Once again, you do not need to obtain a referral from your primary care manager, although there are certain services for which you will need prior authorization before they can be availed. Like the TRICARE Standard beneficiaries, you can also obtain medical health care from military hospitals or clinics if space is available.
For people who are using the TRICARE for Life health care plan, an appointment can be made with any health care provider that has been authorized by TRICARE. In addition to this, medical health care can also be obtained from military clinics and hospitals if they have enough space to cater to you.
If you have enrolled for the US Family Health Plan, then the provider that has been designated to you will monitor all of your medical health care. Under this plan, however, you will not be able to walk into a military hospital or clinic in order to receive medical assistance. You cannot make an appointment with any other provider either, even if TRICARE has authorized it.
Military Clinics and Hospitals
Military clinics and hospitals are usually located on military bases or posts. There are several different kinds of facilities available at these military bases. Multi-service markets are used to refer to health care facilities where both hospitals and clinics are integrated. They can be made up of any number of health care centers, clinics or hospitals. Medical centers are the largest kind of military health care facility. They offer both outpatient services as well as hospitalization. Doctors at these centers are usually trained in many different specialties and sub-specialties. Both civilian and military patients can use them as trauma centers. Hospitals are, in general, smaller than these integrated medical centers. Although they, too, offer the same services (outpatient services as well as hospitalization), they usually have a smaller capacity and, thus, cater to a smaller number of people. They have a highly trained staff, although the staff is usually trained in a smaller number of specialties. Medical clinics are the smallest type of military health care facility. Outpatient service is available at clinics. However, there is no hospitalization service. The staff is highly skilled, but in a smaller number of specialties. Furthermore, some clinics only cater to members who are actively serving in the military forces, while others only provide primary health care.
TRICARE has assigned regional contractors, whose main job is to make contracts with regional health care providers. These health care providers are authorized by TRICARE, and are located in the North, South and the West. Because of the contracts that these providers have formed with TRICARE, you can pay a smaller, negotiated rate instead of paying the full amount. Furthermore, an added convenience of using these network providers is that they will file any claims on your behalf, so you do not need to worry about them. In addition to this, you will not be asked to pay anything other than a cost share or the co-payment. The result is that you end up paying less; all you need to do is pay the cost share to the network provider, while the provider will directly obtain the remaining amount of money from TRICARE.
A non-network provider is a health care provider that has been authorized by TRICARE but has not joined the Tricare network. The first thing that you will have to do if you are visiting a non-network provider is to check whether the provider is receiving patients covered by TRICARE health care plans or not. A provider may not always be accepting patients who are covered by TRICARE. Non-network providers are also located across the United States, in the North, South and the West.
There are two types of non-network providers. A provider is a participating provider if it allows a patient to pay the TRICARE rate when visiting for a certain medical service. This provider will then get in touch directly with TRICARE to obtain the remaining payment. This means that you will only have to pay the cost share when you visit a health care provider and you will not have to file claims either.
In the case of a non-participating provider, however, you will have to make the full payment for a certain medical service. You will also have to file for a reimbursement on your own.
You can book appointments online if you’re:
- A registered user on the TOL Patient Portal
- Booking an appointment at a military hospital or clinic
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