TRICARE Reserve Select Handbook

TRICARE defines an emergency as a medical, maternity, or psychiatric condition that would lead a “prudent layperson” (someone with average knowledge of health and medicine ) to believe that a serious medical condition exists; that the absence of medical attention would result in a threat to the patient’s life, limb, or sight; that the patient requires immediate medical treatment; or that the patient has painful symptoms requiring immediate attention to relieve suffering.

If you require emergency care, call 911 or go to the nearest emergency room. If you are admitted, you may need to obtain authorization (depending on the type of care) by contacting Humana Military.

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You may access care from any TRICARE authorized provider you choose whenever you need it. Referrals are not required, but some services will require prior authorization.

A prior authorization is a review of the requested health care service to determine if it is medically necessary at the requested level of care. Prior authorizations must be obtained prior to services being rendered or within 24 hours of an admission. Some providers may call Humana Military to obtain prior authorization for you. If you have questions about your authorization requirements, call Humana Military for assistance before seeking care.

The following services* require prior authorization:
   

• Adjunctive dental services
• Extended Care Health Option (ECHO) services
• Home health services
• Hospice care
• Nonemergency inpatient admissions for substance use disorders or behavioral health
• Outpatient behavioral health care beyond the eighth visit (October 1–September 30)
• Transplants—all solid organ and stem cell

Humana Military has additional prior authorization requirements. Visit Humana Military’s Prior Authorization list or call 1-800-444-5445 to learn about their requirements, as they may change periodically.

Note: For overseas prior authorization information, see “Getting Care Overseas” later in this section.

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While you are traveling, you may visit any TRICARE network provider or any non-network, TRICARE-authorized provider. You may be required to pay non-network providers directly and file your claim with Humana Military for reimbursement (See the Claims section of this handbook.). You should file the claim with Humana Military, not in the region in which you received the care. You will find claim forms at the TRICARE Web Site.  In the right-hand navigation column, look for “Downloads.”,  then click on “TRICARE Claim Form (DD Form 2642).”

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