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1.     The ABC's of Seeing a Specialist
2.     Inpatient Rates Increase Slightly for Fiscal Year 2005
3.     TRICARE Is for College Students, Too
4.     New Audio Library Answers Your Health Questions
5.     TRRx FAQ's
6.     Contacts
 
 
The ABC's of Seeing a Specialist (Article 1)

TRICARE strives to provide you and your family with the best health care in the world. There may be times when that care needs to be delivered by a specialist.

As a TRICARE Prime beneficiary, you must first obtain a referral before seeing a specialist. However, your role in the referral process is uncomplicated. It’s your primary care manager’s (PCM’s) and Humana Military Healthcare Services’ responsibility to manage and coordinate referrals to specialists.

Why Should I Bother with a Referral?
In a word—money. TRICARE Prime enrollees who see a specialist without first obtaining an authorized referral incur higher health care costs. Treatment is reimbursed at the point of service (POS) level, which means a deductible of $300 individual/$600 family, plus cost-shares of 50 percent of the allowable charge.

What Do I Need to Do?
In nonemergency situations, contacting your PCM is the first step to obtaining specialty care.

Should your PCM determine that you need specialty care, he or she may refer you to a specialist within the TRICARE network of civilian providers.

Your PCM will then contact the health care finder (HCF) by fax, phone or via the Humana Military Web site to begin the process of obtaining a referral authorization, which is approval to seek the requested care.

How Will I Be Notified When the Referral Is Approved?
The HCF will notify you, your PCM and the specialist of the approved referral, either in writing or by phone.

The referral information will outline the number of authorized visits, services and an approved time frame for treatment.

You can check the status of a pending referral by calling 1-800-444-5445 and selecting “to check the status of an existing referral or authorization.” You will then be prompted to give the appropriate information to obtain the status of your referral. This service is available 24 hours a day, seven days a week.

Should your treatment needs extend beyond those initially approved, the specialist must contact your PCM who will then work with the HCF to obtain an additional referral.

If you need to change anything about your referral (e.g., the specialist, the treatment time frame, etc.), contact your PCM. For other questions about referrals, you may contact Humana Military at 1-800-444-5445.
 

Inpatient Rates Increase Slightly for Fiscal Year 2005 (Article 2)
New Rates Effective Oct. 1, 2004, through Sept. 30 2005

Each fiscal year (Oct. 1–Sept. 30), some TRICARE inpatient cost-share rates increase slightly. The following tables highlight the new inpatient rates for fiscal year 2005.*

Inpatient Rates for Civilian Hospital Admissions
Program Active Duty Family Members Retirees, Their Families and Other Eligible Beneficiaries
TRICARE Prime No increase No increase
TRICARE Extra Increases from $13.32 to $13.90 per day or $25 per admission, whichever is greater. No increase
TRICARE Standard Increases from $13.32 to $13.90 per day or $25 per admission, whichever is greater Increases from $459 to $512, or 25% of the hospital’s billed charges, whichever is less. Plus 25% of the allowable charge for separately billed professional services.

Inpatient Rates for Inpatient Behavioral Health
Program Active Duty Family Members Retirees, Their Families and Other Eligible Beneficiaries
TRICARE Prime No increase No increase
TRICARE Extra No increase No increase
TRICARE Standard No increase Increase from $164 to $169 per day, plus 25% of the allowable charge for separately billed professional services

For additional information about cost-shares for TRICARE-covered services, visit the TRICARE Web site. You can also contact Humana Military at 1-800-444-5445 for more information.

* While the inpatient rate increases are technically effective Oct. 1, 2004, there may be some delay between then and the time Humana Military receives direction and is able to implement the change.
 
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Last Reviewed:  December 4, 2007