With TRICARE Reserve Select (TRS) 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 may use either a TRICARE network provider or a 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 TRICARE network provider and the other could be a non-network, TRICARE-authorized provider. Ask if your health care provider(s) is a TRICARE network provider. Visits to a TRICARE 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 provider or a non-network, TRICARE-authorized provider, visit the TRICARE Provider Locator. Humana Military also has TRICARE network provider directories, which you may use to locate providers.
Note: For information about finding a provider overseas, see “Getting Care Overseas” later in this section.
TRICARE Provider Types
Figure 1.1
TRICARE-Authorized Providers
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
May choose to participate on a claim-by-claim basis
Have agreed (when participating) 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.
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 in addition to any applicable patient cost-share.
If you visit a nonparticipating provider, you may have to pay the provider first and file a claim with TRICARE for reimbursement.
You and each covered family member should receive (or may already have received) a (TRS) wallet card when your TRS enrollment is processed through the Defense Enrollment Eligibility Reporting System (DEERS). TRS wallet cards contain key phone numbers and other information to assist you with your health care coverage. If your doctor, hospital, pharmacist, durable medical equipment supplier, or other provider asks to see your insurance card, you may present this card.
If you have not received your TRS wallet card within four to six weeks of submitting your TRS Request Form, contact Humana Military for assistance.
