You receive routine or primary health care from your primary care manager (PCM), and your PCM refers you to a specialist for necessary specialty care. You are guaranteed access to care within specific timeframes, and you may qualify for a travel reimbursement if referred to specialty care that is more than 100 miles from your PCM’s office. This chapter explains these and other details about using TPR and TPRADFM.
Making an Appointment
Contact your PCM’s office directly to make an appointment. There is no need to contact Humana Military to schedule appointments with your PCM or primary care provider. We’ll discuss specialty care appointments later in this section.
The wait time for an urgent care appointment should not exceed 24 hours (one day).
The wait time for a routine appointment should not exceed one week (seven days).
The wait time for a specialty care appointment or wellness visit should not exceed four weeks (28 days).
These access standards begin at the time of your contact with the provider. You should contact your provider as soon as possible. At times, appointments may not be available within the timeframes listed above due to high demand for specialty care services. If the provider does not have appointments available within the access standards, you can choose to schedule the earliest-available appointment with the provider, or you can contact Humana Military for assistance in locating another provider.
You should have access to a PCM whose office is within 30 minutes of your home under normal circumstances. Specialty care should be available within one hour from your home. See the section titled, Specialty Care Far From Home—Travel Reimbursement for information about a travel reimbursement if you are referred for specialty care more than 100 miles from your PCM’s office.
Additionally, it is important to understand your provider’s specific policies regarding cancelled or missed appointments. Some providers charge a missed appointment fee, which is not covered by TRICARE. Please be sure to notify your provider’s office within the appropriate time, usually 24 to 48 hours prior, if you will not be able to make your scheduled appointment. If your provider bills you for a missed appointment, you are responsible for paying this amount and it will not be reimbursed by TRICARE.
