Second Opinions and Point of Service Options
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Getting a Second Opinion
You have the right to request a consultation with another provider for a second medical opinion when you or the initial provider is uncertain about a contemplated course of action. Your PCM or Humana Military may also request a second medical opinion on your behalf. If you wish to seek a second opinion, contact your PCM or Humana Military to explain your situation and ask any questions you may have about the first specialist’s suggested care. Then you or your PCM can request a referral to another specialist from Humana Military. Be sure to indicate the request is for a second opinion.
Point of Service Option
The TRICARE point-of-service (POS) option gives you the freedom, at an additional cost, to seek and receive nonemergency health care services from any TRICARE-authorized provider without requesting a referral from your PCM. For cost details, visit TRICARE's web site.
The POS option does not apply to the following:
ADSMs Newborns or newly adopted children in the first 60 days after birth or adoption Emergency care Clinical preventive care received from a network provider First eight behavioral health care outpatient visits per FY (October 1–September 30) to a network provider Beneficiaries with other health insurance
The POS cost-share is applied when:
- You receive care from a network or non-network TRICARE-authorized provider without a referral from your PCM
- You self-refer to a network specialty care provider after a referral has been authorized by Humana Military to an MTF specialty care provider
- When you are enrolled at an MTF and you self-refer to a network or non-network civilian provider for a routine (primary) care service
Using the POS option results in higher out-of-pocket costs and higher deductibles. POS costs do not apply to your annual catastrophic cap. Note: Prior authorization requirements still apply when using the POS option. |
