You may receive care from any TRICARE-authorized provider without a referral. Some services will require prior authorization (discussed later in this section). Figure 1.1 describes the different types of providers.
You can use either a TRICARE network or non-network TRICARE-authorized provider at any time. For example, if an orthopedic surgeon and a physical therapist are treating you, one could be a network provider and the other could be a non-network provider. Keep track of the types of providers you are seeing. Visits to a network provider will cost you less out of pocket, and the provider will file claims on your behalf. With a non-network TRICARE-authorized provider, you’ll pay more out of pocket and may have to file your own claims.
To find a TRICARE network or non-network TRICARE-authorized provider, visit the provider locator. Humana Military also has a TRICARE network provider directory, which you can use to locate providers in the South region. If you do not have Internet access, call Humana Military Healthcare Services for assistance with locating a provider.
Note: For information about finding a provider overseas, see “Getting Care Overseas” later in this section.
TRICARE-authorized providers are those who meet TRICARE’s licensing and certification requirements and have been certified by TRICARE to provide care to TRICARE beneficiaries. These include doctors, hospitals, ancillary providers (such as laboratories and radiology centers), and pharmacies. If you see a provider who is not TRICARE-authorized, you are responsible for the full cost of care.
There are two types of TRICARE-authorized providers: Network and Non-network.
Network Providers
Non-network Providers
Have a signed agreement with Humana Military to provide care.
Agree to handle claims for you.
Using a network provider is your best option.
Do not have a signed agreement with Humana Military.
There are two types of non-network providers: Participating and Nonparticipating.
Participating
Nonparticipating
Have agreed to file claims for you, to accept payment directly
from TRICARE, and to accept the TRICARE allowable charge less any applicable patient cost-shares paid by you, as payment in full for their services.
May participate on a claim-by- claim basis.
Using a participating provider is your best option if seeing a non-network provider.
Have not agreed to accept the TRICARE allowable charge or file your claims.
Have the legal right to charge you up to 15% above the TRICARE allowable charge for services. You are responsible for paying this amount.
If you visit a nonparticipating provider, you may have to pay the provider first and file a claim with TRICARE for reimbursement.
